No. The hospital has only one pricing system. Patients of all nationalities are on the same price and quality standard.

Q2

Do all the doctors at Bumrungrad work on the same campus?

Yes. We have over 1,200 physicians and surgeons in over 55 specialties and sub-specialties on-site. Many are American Board Certified with other doctors having been trained in either Japan, Australia, or various European countries. As well, a number of our part-time doctors are professors from Thailand’s top medical schools.

The advantage of a fully integrated facility is that it ensures our patients one destination for all medical needs.

Q3

Do you have a pick-up service at the airport arrival gate?

Yes, only at Suvarnabhumi (BKK) airport. Please provide us with your flight arrival time and patient information, prior to your travel date. Additional service charges apply.

Q4

Does Bumrungrad accept credit cards?

Yes. Payments can be made by most major credit/debit cards, cashier’s check, bank transfer, e-payments and cash (Thai Baht only). Please note that personal checks are not accepted. Foreign exchange is available at in-house and nearby banks.

Q5

Does Bumrungrad employ foreign doctors?

All of our practicing physicians and surgeons are of Thai nationality. In Thailand, doctors are required to pass a medical license examination for clinical practice in Thai (Thai Language). However, Bumrungrad does employ international doctors as coordinating physicians, in helping us better understand and manage patients from various different cultures.

Q6

Does Bumrungrad have accommodations for the patient’s family members or friends etc.?

Don Muaeng (DMK) Airport, we currently do not have an airport counter nor provide shuttle service at this airport. Please contact us in advance for transportation service. Payable directly to transportation counter.

For first time visitors, where is the first point of contact in the hospital?

If you are a new patient, please arrive 30 minutes before your appointment for registration at the Sky Lobby (10th floor of BI Clinic building), or at the 2nd floor of BI Hospital building. Please bring a list of medications or herbal remedies, if any, that you are currently taking.

How do the international patients communicate with doctors and medical staff?

English is widely spoken at the hospital. You will be able to speak English with all of Bumrungrad’s doctors, nurses, and customer service staff. We also employ more than a hundred interpreters in various languages, to help with patients who speak foreign languages. Some of the included languages are Burmese, Cambodian, and Arabic etc. See more under Q11.

Q11

How many patients does Bumrungrad treat annually?

We treat approximately 1.1 million out-patients per year, which are about 3,000 out-patients per day. 50% of our patients are Thai and the other 50% from international.

Q12

How would you recommend the most suitable doctor?

If you go to the Make an Appointment page and ask us to recommend a specialist, we will make a recommendation for you based on your selected specialty, the medical information you provide, and your desired appointment date.

What facilities does the hospital have in place, specifically for international patients?

For all patients, our facilities are provided for the safety and convenience:

Medical Coordination Office: Thai and international medical professionals working as administrative staff to consult medical enquiries, coordinate the scheduling of procedures and appointments with doctors and help with follow-up care planning.

Airport Representative Counter: Our airport representative team assists patients upon arrival at Suvarnabhumi International Airport (BKK). Shuttle van service is provided for patients and relatives traveling from the airport to the hospital. Map of Airport Representative Counter

Interpreter Services: The hospital employs more than 100 full-time international interpreters to assist with the many languages spoken by our patients. Hospital interpreter service is free of charge. For special languages interpreters, please contact our customer service in advance. List of Languages Available.

Travel and Visa Services: The service arranges travel needs for Bumrungrad patients and families while receiving hospital care. The Immigration Bureau operates a visa extension service at Bumrungrad once a week to process visa extensions for patients and their families who have doctors’ medical certificates. Services of our Business Center

International Referral Offices*: As of 2018, we now have 46 offices in 26 different countries with 1 Virtual RO, providing special assistance and coordination for prospective patients wishing to seek medical care at Bumrungrad (* independent entities working with Bumrungrad International).

Our hospital is within walking distance of BTS Skytrain, convenient stores and international restaurants (including Halal and Vegetarian).

Q14

What if my preferred doctor is not available?

We would suggest making an appointment with an alternative doctor. Or you may consider changing your appointment date in order to see your preferred doctor. You may also try standby.

Q15

What is International Referral Office and what kind of services do they provide?

International Referral Offices are independent entities working with Bumrungrad. As of 2018, we now have 46 offices in 26 different countries with 1 Virtual RO. The referral offices provide medical enquiries coordination and travel related information in your native languages. There are no additional fees on your hospital invoice for the services of Bumrungrad’s Referral Offices.

What training and licensing do nurses, pharmacists, imaging technicians and lab technicians receive?

Nurses, pharmacists, imaging technicians and lab technicians of Bumrungrad undergo proper training and pass examinations in order to obtain licenses to practice in Thailand. Nurses are re-certified at five-year intervals. Furthermore, ICU nurses must receive higher training in these specialized areas. Bumrungrad staff also receives English language courses and development programs, covering a wide range of patient safety issues.

Q19

What types of in-patient rooms are available?

We offer a wide range of in-hospital accommodations — from standard shared rooms of four beds, single rooms to our suites. All hospital rooms have been designed with the patient’s comfort and safety in mind. Please see details at In-patient Rooms.

Q20

What types of license and credentials do your doctors have?

All of Bumrungrad’s physicians and surgeons are fully licensed by the Thai Medical Council to practice their specialty in Thailand. In addition, many are Board Certified in their specialty from either the U.S., Australia, or various European countries. Bumrungrad's credentialing process requires a formal review of each doctor's qualifications and track record by the Credentials and Bylaws Committee and the Hospital's Medical Executive Committee. These reviews must take place before a doctor may join our hospital. Each doctor then undergoes a review every three years.

A summary of each of our doctor's qualifications is available through our website. Please see Doctor’s Profile.

Q21

Where is Bumrungrad Hospital located and what is nearby?

We are located in Sukhumvit Soi 3, conveniently located near both the BTS Skytrain: Ploenchit and Nana Station. We are in walking distance to many popular hotels, embassies, restaurants and major shopping malls. Map, Direction & Taxi Info

Q22

Why is Bumrungrad well known for international patients (medical tourism)?

Every year, Bumrungrad welcomes over 550,000 outpatient visits and inpatient admissions from over 190 different countries worldwide.

What is the success rate of dental implants?

This depends on where the implants are placed and their function. The best placement of implants is in the front portion of the lower jaw where success can be as high as between 98-100%. In other parts of the mouth, success rates can drop significantly to the 90-95% range.

What are dental implants?

Dental implants are titanium screws that are secured into the jaw bone. They can be a singular tooth replacement or can be a support for a cap or a bridge.

Who is the ideal patient for dental implants?

Anyone in reasonable health who wants to replace missing teeth. You must have enough bone in the area of the missing teeth to provide for the anchorage of the implants.

How long after a dental implant is placed can it be used to anchor my new teeth?

The protocol that was originally developed clearly indicates waiting 90 days for the lower jaw and 180 days for the upper jaw before beginning the construction of the new dental prosthesis that will be supported by the implants.

Does it hurt when dental implants are placed?

The actual procedure to surgically place a dental implant is done under local anesthesia and usually is not painful.

Am I eligible for treatment with VISX-STAR S4?

Yes, if you:

are over 20 years old;

are not pregnant or breast feeding;

are free from corneal/retinal and connective tissue disease, glaucoma and severe dry eye;

suffer from near-sightedness of 1.5 to 12 diopters;

suffer from astigmatism of 1.0 to 6.0 diopter; or

suffer from far-sightedness (hyperopia) of +1.5 to +6.0 diopters.

Is it safe?

LASIK is a well-established, world-class method for refractive correction. By 2009, more than 6,500 procedures had been successfully completed at Bumrungrad International, with thousands performed every year. Complications are rare and will be discussed by your doctor. Additional safety is assured by performing the surgery in a sterile operating theater environment.

Does it hurt?

There are no sutures or injections and only anesthetic eye drops are required. Typically, you may experience mild irritation for the first 24 hours after surgery.

What is the success rate?

Statistically, patients experience a 95% vision correction.

How long does it take?

LASIK is an outpatient procedure that takes about 15-20 minutes per eye. Most patients go home without eye gauze, but a transparent eye-shield is provided for maximum safety. The majority of patients can see well within 24 hours, with the full benefits being realized within 1 to 2 weeks.

Can I do both eyes at the same time?

Both eyes can be done at the same time, however your ophthalmologist may recommend treating each eye separately, depending on your individual circumstances.

What is Abdominoplasty?

Abdominoplasty, also known as a Tummy Tuck, is the surgery of the abdomen to remove the excess skin and fat that may accumulate after pregnancy, obesity or age.

Am I a candidate for Abdominoplasty?

An individual must be in good health, not have any active diseases or serious, pre-existing medical conditions and must have realistic expectations of the outcome of their surgery.

This is an operation which requires patience and stability in dealing with the healing period. There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue. Please consider this before committing to a procedure. If the above describes you and you have the desire to rid yourself of loose sagging skin of the abdominal area, you may be a good candidate for Abdominoplasty.

Normally women seek this procedure after pregnancy - although it is advised to wait until you are finished having children to have this procedure as the skin and muscles can get stretched out again as well as the dangers of your newly taut skin being unable to accommodate another pregnancy.

Also, if you are considering losing weight you should wait until after your desired weight is met.

What are Dynamic Wrinkles?

Doctors call them dynamic wrinkles. Everyone else simply calls them smile lines and frown lines. No matter what you call them, they are the most troublesome of all wrinkles and often are the most difficult to treat. They are our crow's feet, scowl lines, forehead creases, and lip wrinkles. They develop because each time we smile, laugh, or frown, our skin creases or folds in the same way. After making the same expressions time after time, our skin "remembers" these creases even when they are not there. These wrinkles can be improved through laser resurfacing, dermabrasion, deep peels, Botox, and fillers. However, even if these treatments could vanish your dynamic wrinkles will return, because you will continue to make the same facial expressions that caused them in the first place. Interestingly, if you have ever seen anyone who has had one half of their face paralyzed, you may have noticed that the paralyzed side appears younger. This is because they do not move that side of the face, so there are no dynamic wrinkles.

What are Fine Wrinkles?

Fine wrinkles are seen on dry crepe paper skin (usually on the cheeks). These wrinkles are superficial and their removal is relatively easy through skin care, micropeels, and other simple treatments. (See table).

What are Skin Fold Wrinkles?

Skin fold wrinkles are the wrinkles that go from the corner of our noses, around our mouths, and down to our chins. They look like big parentheses around our mouths. They develop within the skin fold (called nasolabial fold by doctors) which is due to sagging cheeks. Because these wrinkles are due to sagging skin, the only way to treat them is by tightening the skin...through a facelift. Just look in the mirror while you are pulling your cheek skin back toward your ears. You will see a dramatic improvement in your nasolabial folds, as well as the skin fold wrinkles.

How Do Wrinkle Treatments Work?

Chemical peels, laser, dermabrasion, and skin care are all guided by the same principles. But to understand them, you first must know a little something about your skin.

Your skin is made up of damaged superficial cells and healthier deep cells. Every day, your old superficial cells die, shed, and are replaced by younger cells. When you are born, the process of shedding a new skin cell takes about 30 days. By the time you are 60, the process takes about 60 days. Thus, as you get older, your complexion becomes dull and lifeless because the cells on your skin's surface are, in fact, older.

Each treatment mentioned above causes uniform destruction and shedding of your old damaged superficial skin cells. This allows healthier deep cells to surface while they are still young and fresh. Each of these treatments organizes and expedites the process of skin turnover and helps you reclaim the skin of your youth. As a result, you will see improvement in some or all of the following skin problems: large pore size, loss of skin vitality, roughness, discoloration, fine wrinkles, acne scars, dynamic wrinkles, and loss of skin tone. (Fillers and Botox are guided by other principles).

Despite their similarities, each treatment works slightly differently and therefore yields a different degree of improvement. No one treatment solves all problems. In general, deeper treatments yield greater improvement but impose longer recovery. To optimize their results, many people employ two treatment options that complement one another, such as laser resurfacing and Botox injections.

When is Abdominoplasty usually performed?

The Abdominoplasty procedure is usually performed when a person is discontent with their appearance in the abdomen region. It is most often sought out after a woman has given birth and does not plan on having any more children. After the extra skin and muscle tissue is removed, the abdomen may not be able to accommodate another child.

What does a typical Abdominoplasty consultation entail?

The surgeon will measure your abdomen and general torso region for an idea of an ideal abdomen size for you. Realistic goals will be decided between Patient and Surgeon. It must be remembered that no amount of surgery can restore skin to former conditions.

How is Abdominoplasty performed?

Abdominoplasty is performed most commonly under General Anesthesia or Light Sleep IV Sedation. Local anesthesia is then used to numb the abdomen.

The Procedure is typically performing thus:

The operation is performed by making an incision in the lower abdomen just above the pubis. The incision can go from hip to hip. It is placed within the bikini line, to be well hidden.

The skin and fat are removed from the abdominal muscles to the bottom of the rib cage.

The belly button is separated from the skin and most frequently all the skin and fat below the belly button is removed. Sometimes, sutures are placed on the muscles of the abdominal wall to tighten one side of the abdomen to the other and thereby flatten the abdomen considerably.

The skin above the belly button is drawn down to the pubis and sutured into position. A new hole is placed in the skin and the belly button is positioned in about the same spot that it existed before surgery.

The new tummy is then sutured into position. One or two drains are placed under the skin and rest on the abdominal muscle, with exits below the pubis incision.

What are the different techniques for Abdominoplasty?

The different techniques pertaining to Abdominoplasty consist of the different incision shapes and placement. Although most surgeons attempt to place the incisions in the most inconspicuous area, this should be discussed with the Surgeon beforehand. An incision following the bikini line is the optimum for concealment purposes although your body's needs will determine the incision placement.

What should I expect post-operatively?

Patients are usually able to walk immediately after surgery and is in fact encouraged to do so 3 or 4 times per day for 1 to 2 minutes each time. Usuall y however, they cannot stand up straight, and walk with a hunched posture. The skin of the abdomen will be quite tight and patients are usually instructed to remain bent over at least 45 degrees for the first 4 to 5 days after surgery.

Patients will often note some back discomfort due to the 45 degree positioning for 4 to 5 days after surgery - Surgeon sometimes give muscle relaxants or valium.

The drains are removed 4 to 14 days after surgery. At the end of 4 days the patient may begin to straighten up and by six days post-op may or may not be fully straight.

You should not exert themselves for at least two weeks after surgery. While the drains are in, bed rest with a very small amount of walking as outlined above is recommended.

If drains are requored for an extended amount of time, patients are notexpected to sit in bed all day. An abdominal pressure garment may be given at a post-operative appointment. These are used for 3 o 6 weeks.

Some swelling and discoloration are normal but are generally minimal and dependent upon the individual.

When will the sutures be taken out and does this hurt?

The drain tube, if used, will be removed in approximately 2 to 3 days. Although your bandages may not be removed until about day 5. Your face will swell, and it appears at it's worse at day three. Your stitches may be removed the same day as your bandages; if surgical staples were used within the scalp area, they may be removed in 7 to 10 days.

Is there much pain associated with Abdominoplasty?

The amount of pain associated with this procedure is quite variable. Some patients note a moderate amount of discomfort, but for some it is more intense.

Patients will often note some back discomfort due to the 45 degree positioning for 4 to 5 days after surgery.

Valium is sometimes given to alleviate muscle spasms of the back and for relaxation.

What are varicose veins and spider veins?

The heart pumps blood to supply oxygen and nutrients to all parts of the body. Arteries carry blood from the heart towards the body parts, while veins carry blood from the body parts back to the heart. As the blood is pumped back to the heart, veins act as one-way valves to prevent the blood from flowing backwards. If the one-way valve becomes weak, some of the blood can leak back into the vein, collect there, and then become congested or clogged. This congestion will cause the vein to abnormally enlarge. These enlarged veins can be either varicose veins or spider veins. Varicose veins are very swollen and raised above the surface of the skin. They are dark purple or blue in color, and can look like cords or very twisted and bulging. Spider veins are similar to varicose veins, but they are smaller, are often red or blue in color, and are closer to the surface of the skin than varicose veins. They can look like a tree branch or spider web with their short jagged lines. Spider veins can be found on both the legs and the face. They can cover either a very small or very large area of skin.

How common are abnormal leg veins?

As many as 60% of all American women and men suffer from some form of vein disorder, but women are more affected -- up to 50% overall. It also is estimated that 41% of all women will suffer from abnormal leg veins by the time they are in their 50s.

Where are the scars located involving an Abdominoplasty?

This is not a scar-free surgery; and depend upon:

the amount of skin needed to be removed,

your body's ability to heal,

if you scar well,

the skill of the surgeon and the technique utilized.

Indeed, in some cases, scarring can be severe. Most surgeons choose to offer their patients lesser scarring techniques that leave a well-hidden horizontal or slightly bowed scar which can be covered by a standard bikini.

What causes varicose and spider veins?

No one knows the exact cause of spider and varicose veins, but there are several factors that cause a person to be more likely to develop them. Heredity, or being born with weak vein valves, is the greatest factor. Hormones also play a role. The hormonal changes that occur during puberty, pregnancy, and menopause, as well as taking estrogen, progesterone, and birth control pills can cause a woman to develop varicose veins or spider veins. During pregnancy, besides the increases in hormone levels, there also is a great increase in the volume of blood in the body that can cause veins to enlarge. The enlarged uterus also puts more pressure on the veins. (Within 3 months after delivery, varicose veins usually improve. However, more abnormal veins are likely to develop and remain after additional pregnancies.)

Other factors that weaken vein valves and that may cause varicose or spider veins include aging, obesity, leg injury, and prolonged standing, such as for long hours on the job. Spider veins on the cheeks or nose of a fair-skinned person may occur from sun exposure.

Why do varicose and spider veins usually appear in the legs?

The veins in the legs have the toughest job of carrying blood back to the heart. The pressure can overcome the strength of these one-way valves. The force of gravity, the pressure from body weight, and the task of carrying the blood from the bottom of the body up to the heart make the legs the primary location for varicose and spider veins.

Are varicose and spider veins painful or dangerous?

Medical treatment usually is not required for varicose or spider veins. However, varicose veins can become quite uncomfortable as well as look unattractive. Varicose veins usually enlarge and worsen over time. They can cause the legs and feet to swell. Although severe leg pain is not common, leg muscles may feel fatigued or heavy, or throb and cramp at night. The skin on the legs and around the ankles also can itch or burn.

In some cases, varicose veins and spider veins can cause more serious problems, and medical treatment will provide benefits. If the veins become severe, they can cause a condition called venous insufficiency, a severe clogging of the blood in the veins that prevents it from returning to the heart. This condition can cause problems like a deep-vein thrombosis (blood clot), or a severe bleeding infection. These usually are caused by injury to the varicose vein. A blood clot can be very dangerous because of the possibility of it traveling from the leg veins to the lungs, where it may block the heart and lungs from functioning. Lastly, because the skin tissue around the varicose vein may not receive enough nourishment, sores or skin ulcers may develop.

Is there a lot of swelling involved with a Abdominoplasty?

There is some swelling involved with an Abdominoplasty. With this type of surgery, and depending upon the case, a lot of tissue can be removed.

When will I be able to see the results?

After the swelling subsides and the drains are taken out you will start to see a difference. However, underlying tissues have been cut and that an Abdominoplasty is a very invasive procedure. The body needs time to heal.

You will in time reap the benefits of this procedure.

What is sclerotherapy? Can it be used as an alternative to surgery?

Sclerotherapy refers to the injection of dilated veins and spider blemishes with medication specifically formulated to cause their disappearance without doing harm to normal healthy veins, the skin or other tissues. Only the finest and highest quality needles are used and strict asepsis is observed, with everything appropriately discarded immediately after use. Sclerotherapy however, is not an alternative to surgery. If you read or are told otherwise, ask questions, be critical and by all means, get another opinion from a qualified specialist. Be wary of high tech sounding terms such as "echosclerotherapy and ultrasound guided sclerotherapy." These are not sophisticated techniques known only to a privileged few, nor are they legitimate alternative treatments when surgical intervention is indicated.

Many cosmetic dermatologists and plastic surgeons and other trained medical doctors treat patients with varicose veins and spider veins as part of their overall practice in which they provide the highest quality care to their patients. But they always refer patients they know they cannot help to qualified associates.

Is treatment necessary?

Varicose veins and spider veins are always abnormal and will not disappear without treatment. Left unchecked varicose veins can lead to unpleasant and even serious complications as skin discoloration and sores, bleeding, ankle swelling and phlebitis. Spider veins, not associated with varicose veins, will likely remain only a cosmetic problem although some patients complain bitterly of discomfort for no other apparent reason. While many persons chose not to treat varicose veins, especially when they are not causing pain or discomfort, in the minority of cases that complications develop, treating the varicose veins after the fact cannot reverse the complications and therefore comes too late.

The agents used to inject veins during sclerotherapy are drugs; can one have an allergic reaction while having these injections?

Allergic reaction during sclerotherapy is a very rare occurrence because the drug is generally trapped in the local area of injection. In extremely rare situations, respiratory and vascular collapse (anaphylaxis) can occur, which is life-threatening. If it does occur, your doctor has methods to manage the symptoms, which is most commonly quite effective.

What are the risks of Abdominoplasty?

As with any surgery under anesthesia, primary risks are associated with the anesthetic.

There are more risks with Abdominoplasty due to the fat and its surrounding tissues becoming necrotic (dead tissue). If the fat becomes necrotic from lack of blood supply, the fat tends to turn orange-ish clear and a little may drain from the incision. Although this is very normal to have fluid this color drain from the incision. There will be fat damage, there will be fluid retention, and there will be blood-tinted drainage.

If the tissue becomes necrotic, or you have a massive die off of fat cells you must have the tissue removed before a major infection develops. This is extremely rare and taking precautions can certainly make a difference:

Do not smoking

Take approriate wound care

Sometimes Liposuction is part of the Abdominoplasty procedure. Even with the ultrasonic technique, patients have been known to receive actual burns from the ultrasonic technique. The fat is actually melted within the body by 'exciting' the fat molecules with high frequency radio waves and is suctioned out. There may be asymmetry, hyperpigmentation (permanent dark spots) from the bruising. Major blood loss is a factor is some cases.

Another risk is Pulmonary Thromboemboli - a blood clot that breaks free and travel to the lungs. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma. Pulmonary Thromboemboli can occur within three weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. Pulmonary Thromboemboli can occur suddenly, without warning.

How long does an Abdominoplasty last?

This procedure can last for many, many years. If there are no large weight gains, and no pregnancies after the tummy tuck then the changes can be relatively permanent.

Relaxation of the tissues can reoccur but not to the extent prior to surgery

Why is scar tissue a problem?

Scar tissue limits range of motion, and in many instances causes pain, which prevents the patient from functioning as he or she did before the injury.

How is scar tissue different from other tissue?

When viewed under a microscope, normal tissue can take a couple of different fashions: dense, regular elongated fibers running in the same direction, such as tendons and ligaments; or dense, irregular and loose with fibers running in multiple directions. In either instance, when tissue is damaged, it will heal in a haphazard pattern--or scarring--that results in a restricted range of motion and, very often, pain.

Why is laser treatment safe?

The laser is safe and effective because of its unique ability to selectively treat the pigmented lesion without adversely affecting the surrounding tissue.

Is treatment with the laser painful?

Treatment with the laser is more comfortable and requires less recovery time than some other treatment methods. Most patients do not require anesthesia. In some very rare cases, depending on the nature and the location of the lesion and the patient's age, the physician may elect to use some form of local anesthesia. Pigmented lesions that have not been effectively removed by other treatments may respond well to our laser therapy, providing prior treatment did not cause excessive scarring or skin damage.

What is Blepharoplasty?

Blepharoplasty removes the excess fat, skin and atrophied muscle from the upper and/or lower eyelids. It is a very popular procedure as hooded eyes seem to lack luster and seem old or tired by many patients.

Many individuals who choose this procedure are very aware that their upper eyelids have seemed to disappear within the herniated fat of the upper eye area. Fat herniation is quite normal and will happen to everyone with age. However some individuals have herniated fat in the upper area of their eyes even in their early teens.

Sometimes a blepharoplasty can improve an individual's vision. This is achieved by removing the excess fat and skin that may block an individual's peripheral field of vision.

Whatever the individual case, the purpose of a blepharoplasty is for the aesthetic appeal that wider, youthful eyes possess.

How does the laser treat pigmented lesions?

The laser will specifically target dark concentrations of melanin using light energy. Pigmented lesions are lightened or removed when the laser light passes through the skin and is absorbed by abnormal concentrations of melanin. The rapid absorption of light causes the melanin to destruct, reducing the concentration of melanin. A laser produces a beam of highly concentrated light. Different types of lasers produce different colors of light. The color of light produced by a particular laser is the key to the laser's effect on pigmented lesions. Particular colors of light are absorbed by specific colors or pigments in the skin. The laser's light energy, which is absorbed by the targeted lesion, eliminates the appropriate pigmented cells. Pigmented lesions vary in color, depending on the type of lesion and the natural tone of the person's skin. This means that not every pigmented lesion absorbs the same color of light. Earlier lasers emitted only one color of light, often requiring doctors to use two or more lasers and repeated sessions to treat pigmented lesions. The VersaPulse C Aesthetic Laser produces short pulses of a wide spectrum of light colors to treat the full range of pigmented lesions. The entire treatment involves no incisions.

How is the Blepharoplasty performed?

Blepharoplasty is usually performed using local anesthesia and light sleep sedation or General.

The incisions are made within the natural creases of the eyelids. The Surgeon removes the herniated fat and excess skin and sutures the incision with very fine hair-like sutures.

Removal of the entire fat pads underneath the eye should be discouraged. Excessive removal of this fat is disastrous in most patients, as it often results in hollowness or a dark, sunken appearance. Minimal removal has proven quite beneficial in those who may need it - in those who do not, only the excess skin should be removed.

Is there much scarring with a Blepharoplasty?

Some scarring should be expected, although the scarring associated with blepharoplasty is quite minimal and practically non-existent after several months.

The scars are placed within the normal creases and folds of the upper and lower eyelids so that when the eyes are open the scars are invisible. With lower blepharoplasty, where the fat is to be removed with no skin excision, the incision can be made either on the inside of the eyelid or under the lash line. Many surgeons prefer the transconjuctival incision with fat removal-only cases.

At what age is Blepharoplasty performed?

There is no set age when blepharoplasty is performed, however the usual ages that patients start making consultation appointments for blepharoplasty is from 35 upwards. It is however highly individual and excess skin and fat around the eye area may be desired to be removed younger than 35 years of age.

Will a Blepharoplasty get rid of my eye wrinkles?

A blepharoplasty is not designed to remove the wrinkles. It is designed to remove the excess skin and herniated fat from the lid areas only. Other procedures are available to aid such complaints; Chemical Peels and Laser Resurfacing can help soften wrinkles around the eye significantly.

What should I expect post-operatively?

There will be swelling and there may also be some bruising but some patients are prone to bruising more than others.

The eyelids may feel tight and sore as the anesthesia wears off, but medication should control discomfort. Vision may be a blurry for several days due to the swelling and eyes may be watery or may be dry. There should not be extensive pain.

The pain as associated with blepharoplasty has been described as mild discomfort, as if the skin was sunburned and the eysballs irritated.

When will my stitches be taken out?

Stitches are normally removed after 3 to 5 days. There may be a stinging sensation form tugging on the sutures while removing them.

When will I be able to see the results?

After the swelling goes down you will be able to see a definite difference.

What are the risks of Blepharoplasty?

It is possible to develop asymmetry during healing or excessive scarring if you are prone.

You may experience difficulty in closing your eyes when sleeping. In rare instances this condition may be permanent.

If you have thyroid problems (hypothyroidism or Graves' disease) dry eyes or insufficient tearing, circulatory disorders or high blood pressure, having blepharoplasty may be more risky for you than an otherwise healthy individual.

Other disorders that may increase your risks are myasthenia gravis, cardiovascular disease, diabetes, a detached retina or glaucoma (and other high pressures of the eye), poor circulation and poor elasticity.

Sometimes the eye area will not heal correctly and you just may have to have an additional surgery to correct it.

What are the risks of Breast Augmentation?

Although extremely rare, it is possible to bleed post-operatively resulting in another surgery to control and drain the collected blood. You could develop a post-operative infection and need to have the implant removed, the infection dealt with and still have to wait for several months before an additional surgery can be performed to re-implant. Loss of sensitivity is common, although temporary. Permanent sensation loss in the areola (nipple) area or breasts, in general, can and may happen. There is also the possibility of developing a Seroma which is a mass caused by the accumulation of serum fluid within a tissue or organ. Or a Hematoma which is a localized mass of blood that is typically confined within an organ, tissue, space, or potential space and may be a result from a broken blood vessel.

There is a risk of Capsular Contracture (the evil scar tissue encapsulating the implant, hardening around and squeezing the implant). This rarely ever goes away on its own. Nor does it tend to lay dormant after a revision surgery is performed. It may happen due to bacteria on the implant, surgical implements or airborne and the body attempting to place the foreign body as far away from itself as possible. Or it may develop after injury. If this happens, you can develop pains, hardening, deformity and deflation of the implant. It sometimes even happens again after the surgery to remove the scar tissue has be performed.

There is a chance of rippling (wrinkling or indentations from the implant) being apparent, especially when one has no breast tissue and chooses to go over the muscle. It is possible that the implant can shift and push through layers of tissue, showing through the skin. The implant can deflate or rupture from an injury or from wear and tear from an improperly under filled implant (even your breathing motions can cause creasing in the implant causing it to weaken at these creases). Even an overzealous doctor performing a mammogram can rupture your implant. You can have a complete deflation within several hours if it is an un-encapsulated saline-filled implant. If it is a silicone gel-filled implant, you may not know for months or years. Of course either way, they will have to be replaced. Then there is always a risk of hematoma and scarring. Also, difficulty in early breast tumor detection is possible when you have either silicone gel (more pronounced) or saline-filled silicone shelled implants.

There is also the risk of disappointment in size. A lot of women wish they would have gone bigger. Realize that when you are doing the rice test that they will have to add a little more to make up for the tissues and/or muscle flattening the implant a little if you choose the submuscular placements. When you pre-operatively try on the larger bras and fill them out a bit, they are on top of your body, probably lifted, as well, by an under wire. Take this into account and communicate with your doctor, the results you really want.

There is also the disappointment in the implants not lifting the breasts as you would like. This is not a breast lift this is an augmentation. If it is lift you want as well as augmentation, get them both. After your augmentation surgery, the breasts will be heavier than what you are accustomed to. The heavier weight will speed up the sagging process especially if you go around braless all of the time.

There is the possibility of extrusion of the implant, breast tissue atrophy from the force exerted by the implant. This is according to the F.D.A. and you can read the info on their site by visiting: Breast Implants: An Informational Update.

Can a woman breastfeed after Breast Augmentation?

The answer is yes.

A lot of women ask if they can breast feed after Breast Augmentation Surgery. For the vast majority of women who have BA breastfeeding is no more difficult with implants than without.

Breastfeeding is a growing concern with patients who have had Breast Augmentation surgery. In previous years, women who received implants were married and had already finished with childbearing. However, more and more single women, and women who have not finished or even begun childbearing are having the surgery.

In 1992, the first report of a Silicone Illness hit the media. At that time there was fear that breastfeeding with silicone implants would endanger the child. There has been studies performed to show this not to be the case. The main reason being that the silicone molecule is too large to pass into the milk ducts.

Particularly with the belly button approach, the breast tissue and ducts are not disturbed, cut or affected. The procedure literally takes place under all of the breast tissue, not going through it. There is no evidence that silicone from the implant shell enters the milk.

However, with other incision locations and techniques other than the TUBA and trans-axillary, it is quite possible to disrupt the mild ducts and lines resulting in blocked ducts during a pregnancy. This has been known to happen with a peri-areolar technique resulting in additional surgery to unblock the milk ducts.

What Is Laser skin rejuvenation?

Laser skin rejuvenation treatment is a revolutionary way to combat the signs of aging. This non-invasive procedure stimulates smoother, healthier looking skin without the extensive investment of time and money required by other skin resurfacing treatments.

Can implants achieve lifting of sagging breasts?

Although implants do not lift up a sagging breast, they do help mildly sagging breasts appear less saggy. They do this in two ways:

1. Implants take up some of the slack in loosened skin thereby increasing the volume and decreasing the saggy look.
2. Implants, to a mild extent, rotate the lower portion of the breast upward, making the breasts appear less saggy.

For moderate or severe sag, a lifting procedure or a lifting procedure with implants is usually performed.

How Is The laser skin rejuvenation procedure different than other anti-aging treatments?

Laser skin rejuvenation treatment is unlike any other skin resurfacing treatment. Your skin is not subjected to harsh chemicals or the intense aftercare of other facial rejuvenation procedures. Patented technology protects the sensitive surface layers of your skin, allowing the laser light to penetrate to a deeper level and stimulate new collagen growth.

Do breasts with implants experience sagging over time?

All breasts relax as time goes by. This is because:

the weight stretches the skin

elasticity is lost with age

the amount of breast tissue often decreases as the person gets older.

These three factors mean that breasts can be expected to relax and sag whether or not there are implants present.

The implants add some weight to the breast, which may increase the rate of relaxation, and yet implants and surrounding scar tissue can provide some internal support for the breasts.

The overall result is that usually the breasts sag less - more so if you wear a properly fitting bra regularly.

Will my implants feel like natural breasts?

This issue depends much upon a few factors:

Pre-existing tissue: The more natural tissue you have pre-operatively, the more of a chance you have of feeling "natural" post-operatively. However, if you have Cohesives or overfilled saline implants, regardless, your breasts will feel firmer than natural breasts.

Implant surface: Smooth-surfaced implants are thinner than textured-surfaced implants. Although very slight, patients having had both often report that they can feel a difference.

Implant placement: You may hear that unders look more natural than overs - when in fact, all cases are different. Overs actually move more naturally than unders but may have a pronounced upper pole fullness (especially in overfilled implants). Unders tend to "jump" and twitch when you use the pectorals during every day movements and working out. This may be a matter of opinion and preference rather than an effect which produces a blanket statement.

Thickness/thinness of skin: The thicker and springier your skin the less the implant edges will be felt. Thinner skin allows more a more palpable result. hence thin-skinned individuals often opt for under placement.

How does The laser skin rejuvenation procedure work?

Laser Skin Rejuvenation employs a revolutionary approach to skin rejuvenation which combines a cooling cryogen spray and a laser to give you optimal results with the minimal inconvenience. The protective cooling spray is applied to the skin, allowing Laser Skin Rejuvenation light to pass harmlessly through the upper layers of your skin, stimulating the cells deep below the surface that produce natural collagen. The collagen and elastin fibers continue to multiply after your treatment, and you will continue to see improved results over the months ahead.

Should I pre-medicate before I have dental work, once I've had my Breast Augmentation?

Some may consider this a controversial subject and scoff at the idea of a bacteria-induced infection or case of Capsular Contracture (CC).

When an individual has dental work, even a routine cleaning, plaque and bacteria are released from their holds and introduced into the blood stream via your gum tissue. The gums are often lacerated, even slightly, during dental work creating a 'doorway' in which bacteria may enter.

When a significant amount of bacteria is present in the body, they will seek out weakness in the body to stronghold themselves and replicate. Any foreign presence within our bodies (i.e. breast implants, lip implants, hernia repair mesh, etc.) is a prime target for these infectious intruders.

Although it is not technically proven that dental work and Capsular Contracture (CC) are related there are increased instances of CC thereafter.

NOTE: It is even cautioned to those with pacemakers and aorta catheters to take antibiotics when going to the dentist so mammary implant recipients should be no different.

Will I have stretch marks after my Breast Augmentation? How can I keep this from happening?

The stretch marks are caused by an abrupt expansion of the tissues. When the expansion is very gradual stretch marks are practically non existent.

An individual's elasticity varies.

Some patients develop stretch marks from growth spurts during puberty, muscle tissue gain from weight lifting and pregnancy. Some individuals never develop stretch marks and still others are very prone to them.

Mature stretch marks are very difficult to remove. You can tell a stretch mark is mature by the age of course and by the color - which is usually white. Deep fissures which are purple in color can scarcely be removed with treatments short of excision. This means that those microdermabrasion treatments that you have been getting are probably going to do nothing but empty your pocket book. The white marks CAN be darkened using a flesh-colored pigment implanted using micropigmentation.

There is still no successful treatment for the removal of stretch marks. Some swear by Shea nut butter, others, olive oil. Some swear by Retin A as a solution to the red lines that may develop in the early stages of stretch mark formation. Ask your surgeon before doing anything other than what he or she instructs. There is no guarantee that stretch marks will not develop but medical science has faith that a proven method of removal will be discovered, eventually.

How long does a treatment take?

Laser Skin Rejuvenation treatment is so quick and easy, that many patients come in for treatment during their lunch hour. The procedure takes between 15 and 30 minutes, and there are rarely any side effects. You can reapply your make-up right away and carry on with your day.

You can also cause yourself more pain by not abiding by your surgeon's instructions and over exerting yourself.

Is the procedure painful?

Laser Skin Rejuvenation treatment can be performed on any facial area - around the eyes, mouth, cheeks, chin - with minimal discomfort. A topical anesthetic cream can be used on extra sensitive areas, but no injections are needed.

Should I wait to get my implants if I am considering weight loss?

Although you may wish to get your implants at any time, if you are considering losing any significant amount of weight (15 lbs. and up) be prepared to notice sag if you lose breast tissue.

If you have very small breasts and get implants then lose weight, there shouldn't be a significant problem with sage since your breast envelopes were not large to begin with. You could safely lose the weight and suffer no ill effects to your breasts if this is the case.

How long will it take to heal?

One of the most outstanding features of laser skin rejuvenation treatment is that there is virtually no down-time associated with the procedure. After a session, the area may appear red for up to an hour. However, make-up can immediately be applied. No wound is created, therefore there is no healing time required!

How many treatments are needed, and how long will it last?

Clinical studies suggest that several treatments are needed to stimulate new collagen growth. We also recommend regular touch up treatments to sustain the continued growth of new collagen.

Should I wait to get my implants until after having children?

Although you may wish to get your implants at any time, if you are considering having children within the next year or two, it is advisable to wait since the effects of weight and breast tissue gain and loss will affect the appearance of your breasts.

However, if you plan on waiting on having children you should know that a postpartum lift is possible.

What are the side effects?

Laser skin rejuvenation lasers and light sources are among the safest units on the market.

How big should I go?

This is totally up to you!

if you are asking what is the average size - C and D's are pretty common.

if you are asking what size would help balance YOUR figure - try the hip-bust ratio. Say for instance if your hips are 36 inches, your breasts can be 34 to 36 inches and up (around) and you will look more like an hourglass as opposed to a pear.

Am I too old or too young?

Although there is no set age, it is best to wait until your breasts have finished developing. You can better determine this with your OBGYN if you are a longstanding patient of his or hers. This can vary and although you may think you have finished maturing by 18 or 19 - your breasts will continue to go through changes well into your early twenties.

The youngest is usually 18 although in special cases of pronounced asymmetry and reconstruction - prostheses can be used on persons younger than 18. These younger cases are very specific.

On the other side of the spectrum, women in their late 60's who have gotten breast implants. When we are older the only thing that may stop us from having breast augmentation surgery is general health so be sure to have a physical to see if you are in good health to properly heal and handle the anesthesia factor.

How can I tell my family?

How you tell (or if you choose to tell at all) is up to you. All families will react differently.

You can begin to tell them how you feel regarding your appearance, about your lack in breast size making you feel less feminine, etc.

Make a list of the reasons you want breast augmentation, go over these reasons in your head.

Let your family know how you feel, they may not be completely supportive at first - but they usually come around.

What Are The Available Cosmetic Fillers?

Over the years a variety of filler agents have been successfully used. Each filler is a different material and the duration of filling may vary between the different substances.

Bovine collagen (Zyderm® and Zyplast®) was approved by the FDA 2 decades ago. It was the first filler agent to become very popular in the United States. Typically it is used for smile lines and other wrinkles, lip enhancement and scar correction because bovine collagen is derived from cow collagen, skin tests on the arm are required in an attempt to determine collagen allergy. Results, after treatment, typically last 2-6 months.

Human collagen (Cosmoderm® and Cosmoplast®) is used much like bovine collagen. Typically human collagen is used for smile lines and other wrinkles, lip enhancement and scar correction. These materials are among the more popular filler agents for lip enhancement or for the patient who likes collagen, but prefers not to have bovine collagen. In contrast to bovine collagen, human collagen treatment does not require skin tests. Results typically last 2-6 months.

Among the newer filler agents are those containing non-animal stabilized hyaluronic acid . This sugar-like material is highly popular in Europe and Canada. Recent FDA studies have been undertaken for 2 different hyaluronic acids (Restylane® and Hylaform®). Generally skin tests are not required. The material is soft and is very popular for the treatment of smile lines. Results typically last 3-8 months.

Radiance® is a filler agent made up of calcium material called calcium hydroxylapatite. This material is approved by the FDA for vocal cord injections and has also been used for the treatment of wrinkles. It is unique among fillers in that results can last up to 2 years. This agent is very popular for those patients with deeper smile lines who want longer lasting results.

What type of anesthesia should I choose?

The type of anesthesia is usually not your choice. Depending on your particular case, your surgeon will make the decision.

Do birth control pills cause breast tissue growth?

An increase in estrogen/progesterone causes a subsequent increase in breast size.

If you are planning on taking birth control pills be advised that there are other side effects than simple breast growth.

If you smoke you shouldn't take the pill, if you have circulation problems or high blood pressure, you shouldn't take the pill. There are many contraindications and considerations involved with this.

Please see your OBGYN for more information and a complete exam before you take any type of hormonal supplement.

What Are Cosmetic Fillers?

Fillers are materials that are placed into deeper lines and wrinkles. Filler agents typically are used for those wrinkles that are too deep to be treated with lasers. Most commonly filler agents are used for smile lines wrinkles, between the eyebrows, sagging cheekbones or to enhance the appearance of upper and lower lips. Acne, chicken pox and other depressed scars can also be improved.

What Kind Of Reactions Can Occur After Cosmetic Filler Injections?

Reactions to filler agents are rare and generally resolve with time. Some common injection-related reactions might occur, such as swelling, redness, pain, itching, discoloration and tenderness at the implant site. They typically resolve spontaneously within several days after injection into the skin. Other types of reactions are very rare, but occasional patients do experience localized reactions thought to be of a hypersensitivity nature. These have usually consisted of swelling at the implant site, sometimes affecting the surrounding tissues. Redness, tenderness and rarely acne-like formations can be seen.

Will my areolae stretch after augmentation?

Stretching of the areolae is very common and sometimes unavoidable. This can create more sag in breasts that are already saggy although the usually stretching is from the pressure of a tight breast envelope. If you have less tightness, you will usually experience less stretching.

In persons with peri-areolar lifts and areolar reductions - some surgeons use permanent sutures which are usually made from prolene, mersilene or even Gore-Tex around the areolae to keep them from stretching again.

What Can I Do To Optimize Cosmetic Fillers Results?

Filler agents are ideally combined with BOTOX® injections that are used for wrinkles caused by too much muscle tone. Wrinkles such as frown lines, crow’s feet, marionette lines and vertical lip lines are better treated with BOTOX® than a filler agent. Ideally anti-aging skin treatments will include not only filler agents and BOTOX®, but also skin collagen improvement lunchtime laser procedures and skin tightening Thermage Non-Surgical Facelift treatment.

I went on several consultations and every doctor had a different opinion of what would be best for me. What should I do?

All surgeons are different, hence different opinions. Don't expect every surgeon to agree, but do expect to have to do your own research as well to better understand what techniques and options can get you what you want.

Do remember that you are not the doctor and to listen, to take notes at your consultations and reflect upon each surgeon's recommendations.

How Do I Find Out If I Am A Candidate For Cosmetic Fillers?

Our staff will be happy to discuss Cosmetic Filler for Wrinkle treatments with you.

I have fibromyalgia(or multiple sclerosis, etc), is it safe for me to get implants?

This is up to you and your primary care physician, although I have friends who have both disorders and breast implants, nothing has gotten worse (or better) since the implantation of their prostheses many years ago. The FDA released information stating that the IOM concluded that implants do not cause nor contribute to disorders such as these.

It must be said that those predisposed to have disorders may experience the onslaught of such after having been exposed to high levels of stress, trauma, surgery, foreign bodies, infections, high blood pressure, accidents, etc.

I have Poland's Syndrome (pectus excavatum, pectus carinatum, etc) and have been told breast implants will help me look "normal" - is this true?

Many patients with Pectus Excavatum and Carinatum have gotten breast implants to give the illusion of a normal chest conformation. Patients with Poland's syndrome have also gotten one implant or two different sizes when there is considerable asymmetry involved with their disorder. In any case, please seek out a surgeon who is well-experienced in cases such as these.

Should I try BRAVA or Breast Enlargement Pills before choosing to undergo BA with breast implants?

As far as breast enlargement supplements, all supplements are not regulated by the FDA - only their preservatives and food dyes are regulated, these herbal supplements are not the exception. Please be careful when purchasing these items. Some of them contain herbs that are contraindicated with other medications or herbal supplements and can even cause heart palpitations or nervousness. Just use your best judgment when taking something like this and go over the ingredients list. Remember that 'if it sounds too good to be true, it probably is'.

How much is breast augmentation going to cost me? What about if I need a revision?

This definitely depends upon your region, surgeon can range from $2,500. to $10,000. and up. Prices may vary due to region, surgery bids, the newness of practice, marketing ploys, the occasional "special", demand of surgeon, etc. These prices may or may not include, operating room coasts, anesthesia, lab work medications, and more so be sure to ask beforehand and get it in writing.

If you are in need of a revision there is little else you can do if nothing was determined beforehand, but pay the fees and move on. So please determine revision stipulations beforehand and get this in writing as well. Such things as CC, infection and others are usually not covered (although some surgeons do cover this). Surgeon error should be covered at the surgeon's expense so please review the practice's revision protocol before booking your surgery. It is better to prepare for the worst and hope for the best than be hit by an avalanche of additional postoperative fees in your time of misfortune.

What types/brands of breast implants are used for breast augmentation?

The Plastic Surgery Department at Bumrungrad International uses Mentor® saline and silicone-based breast implants. The decision whether to use saline or silicone-based implants is up to each individual patient and can be discussed in detail with your plastic surgeon.

In December, 2006, the FDA approved the return of silicone breast implants to US markets, after finding no evidence that silicone implants were responsible for any serious diseases. Saline breast implants have up to 4% risk of leaking within the first four years after surgery. For more information about breast implants please visit www.mentorcorp.com

Is there a warranty should an implant fail?

Should a breast implant fail, the Bumrungrad Plastic Surgery Department can claim the case through the Mentor® distributor in Thailand. Mentor® covers the cost of the replacement implant; however, they do not cover the cost of the additional surgery.

Am I a candidate for Mastopexy?

If you have no serious health conditions, are not prone to keloid scarring and have noticed that your breasts have started to sag and the effects of gravity are wreaking havoc - you may be a candidate for Mastopexy. An ideal Mastopexy candidate should be mentally and emotionally stable and have realistic expectations as well. When a woman ages, the breast skin loses elasticity and firmness and the breasts may tend to droop as the years creep up. Mastopexy can reduce the extra skin and give the breasts their former, firmer shape and feel.

What is Mastopexy?

The Mastopexy or breast lifting operation is really several different procedures. Each of the different operations has as its intended purpose to lift the breast up and position the nipple in the position that it was in before sagging occurred. Sagging occurs due to three circumstances either alone or in conjunction with each other. First, after pregnancy and breastfeeding the breast has become stretched and the skin loosened. Frequently there is actual loss of some of the breast tissue and this allows for sagging also. Second, weight gain and loss can stretch the skin and also create sagging.

Third, the process of aging and the effects of sun and gravity tend to decrease the elasticity of the skin and this can be a significant factor creating sagging of the breast. The goal in all these instances is to move the nipple back to a higher position and to reshape the breast to create a more beautiful appearance. Most often the need for excess skin removal is apparent.

Who is a candidate for the laser?

Almost anyone is a proper candidate for the CO2 laser. Lighter-skinned and very dark-toned patients tend to heal the fastest. Those with olive skin will usually have the redness last longer. Medical conditions such as keloid formation or other autoimmune disease must be approached with extreme caution.

When is Mastopexy usually performed?

Usually, after pregnancy or after pregnancy and breast feeding there is a lot of breast tissue loss. Sometimes it is just age or even a drooping caused from not wearing a bra through most of one's life. Mastopexy is often sought out by women who have either been pregnant or have gained a lot of weight and have since lost the weight. A Mastopexy will transform a sagging breast to its former youthful appearance. However, if you are planning to have children (or additional children), you should postpone your Mastopexy until after you are sure you are not going to bear children any longer. If you choose to have a child after having had a Mastopexy you will only stretch your skin even more, and even thinner this time, and will have to get another Mastopexy. If you should decide to have children after a Mastopexy, your breastfeeding ability should not be disturbed as the milk ducts should be left intact and undisturbed (unless it is the anchor incision technique where disturbance is quite possible). Discuss with your surgeon the techniques he prefers. Other than that, a Mastopexy can be performed at usually any age (under 18 with parent's permission) if you are in good health and meet certain emotional criteria (such as stability).

What should I expect before, during, and after the laser resurfacing procedure?

After your initial consultation with the physician, you will be given several papers with which to familiarize yourself. These include consent forms, and pre- and post-operative expectation forms. If you then decide to schedule a laser procedure, you will need to come in to the office to finalize your pre-operative preparations. At this time, you will also consult with our esthetician and receive several necessary prescriptions.

A few days after the procedure, and while the skin is rebuilding from the bottom up, some weeping will occur as new collagen is formed by the dermal layer. Minimal to moderate postoperative swelling will occur. Dressings or ointments are used to cover the treated areas and speed the healing process. As the skin heals, the fresh new skin will have a pink quality which will fade over a period of several months. This is easily camouflaged by makeup which can usually be applied in 6-10 days, depending upon your skin’s response to treatment. All laser resurfacing procedures are performed under local anesthesia on an outpatient basis.

What does a typical Mastopexy consultation entail?

At your consultation, your surgeon should measure your breasts and general torso area to determine a natural and aesthetically pleasing position for your breasts and areola/nipple complex post-op. You should provide your surgeon with photos of your breasts previously in life, if possible. If not, a bathing suit photo may help. Your surgeon should take into account your skin condition and (i.e. elasticity and thinness) and age. Sometimes a surgeon will offer the option of having an implant inserted if there is barely any breast tissue remaining.

Your surgeon should discuss with you the details of how a Mastopexy is performed, explain the possible risks and complications involved and any post-operative special care instructions. He/she should also discuss with you ALL costs involved so that you are not surprised by hidden costs. Discuss with your surgeon any questions or concerns you may have before deciding whether or not to commit to Mastopexy.

How is Mastopexy performed?

Many Mastopexy procedures are performed using light sleep or general anesthesia.
The crescent Mastopexy calls for the removing of a crescent of skin above the areola moving the nipple upward and suturing the nipple into the new location. The full Mastopexy requires incisions fashioned in such a way as to actually create a new breast envelope. This allows for the repositioning of the nipple and the reshaping of the breast. Either of these operations can be performed in conjunction with a breast augmentation.

Roughly, Mastopexy takes 1 & 1/2 to 4 hours to perform.

The Crescent Lift: This technique involved removing a crescent-shaped piece of tissue above the areola and suturing the tissue higher. This creates a minor lift for patients who have slight ptosis.

The Benelli Lift: This technique is considered less invasive and was designed with the scars being around the areola. With the Benelli, a donut shaped piece of tissue around the areola border is removed and the surrounding tissue sutured to the areola. The incisions are normally closed with purse string sutures. Sometimes a little more tissue is removed above the areola to compensate for a lifting effect when it is sutured.

The Benelli-Lollipop: This lift is the same as the above but with straight incisions from under the areolae to the mammary folds (crease). This is for those who have medium ptosis, too much for the Benelli only and too little for a full anchor incision.

Full Mastopexy: The most commonly used technique is with an anchor shaped incision that starts at the base of the areola, vertically to the where the breast meets the rib cage. The incision then cuts out a crescent shape piece of skin right above where the breast meets the rib cage. Nipple re-positioning is necessary with this technique as the nipple must be removed. This is considered a major scarring technique but it sometimes necessary with severely sagging breasts.

In any case, the goal of the Mastopexy is to rid the patient of excess sagging skin and re-contour the breast in a fashion that is both pleasing to the eye and the touch. For the most part, the suture lines (scars) will fade within a year, and more so after 2 years. Those scars around and in the areola area seem to fade and flatten faster than in the regular unpigmented area. Silicone sheeting is sometimes used to hasten the flattening and fading of a scar

What are the different techniques for Mastopexy?

The amount of sagging determines the best procedure to be performed. It is important to decide whether augmentation or reduction should accompany the uplifting procedure. The procedure that one elects to undergo is determined by several factors. First and foremost is the amount of sagging or ptosis (pronounced: toe-sis) present. When a slight amount of ptosis is present then a Crescent Mastopexy can be performed. The nipple can be uplifted 2 to 3 centimeters. The incision and therefore subsequent scar is around the top of the areola (pigmented skin). Should a greater amount of lifting be required an incision will be needed that completely surrounds the areola with a vertical line dropping down the center of the breast to the bottom of the breast and sometimes a horizontal incision at the bottom of the breast in the crease between the breast and the chest.

Also there are the undesirable scars of the Anchor (standard) Mastopexy, the Lollipop (or keyhole) Mastopexy and the newer technique invented by Louis Benelli, the Concentric Mastopexy. Also known as the Doughnut, Donut, Peri-Areolar or Concentric or Benelli Mastopexy.

What should I expect post-operatively?

Sutures will have been placed underneath the skin. These will dissolve over several months. Sutures will have been placed onto the skin and these are most frequently the type that will dissolve in one week. A special tape is placed over the sutures to help protect the wound. A bra will be worn continuously for 21 days, 24 hours per day. Instructions on bra removal for washing will be given after the surgery. There is generally very little pain after this operation and only a moderate amount of swelling. The patient may return to work in 3 to 4 days unless the work involves bending or lifting. Walking may be resumed the day after surgery.

More than likely, a surgical will have been be put on you over your gauze bandages. This may be replaced by another bra or you may be asked to wear this particular bra for about 21 days - non-stop. This should be adhered to as non-compliance could affect your end result and or healing. Your stitches will be removed if they are of the non-dissolving kind. If not the special tape will be removed by you in the shower at the end of the 21 days.

It is quite possible to have loss of sensitivity in the nipple and breast skin due to the swelling. The swelling blocks the nerves ability to send and receive pain and pressure messages to and from the brain. This may resemble a numb feeling and is quite normal. Most sensation returns within 1 to 3 months or possibly up to a year or more. Unfortunately, some instances prove that the loss of sensation is a permanent one.

Is there much pain associated with Mastopexy?

Normally, there is not a severe sense of pain. Although, discomfort and soreness is what is most often described by patients. Your prescribed pain medications should alleviate the pain associated with Mastopexy. However, if you feel as if your pain is severe, do not hesitate to call your surgeon or the staff in call.

You will experience more pronounced pain if you are to remove your support bandages and bra for longer than what is necessary to sponge off. You may also interfere with your end result by going braless soon after your procedure. It is advisable to wear a bra at least for most part of the day and evening -- sleeping without -- if you must. Especially if your breasts are larger than an A cup.

Where are the scars located involving Mastopexy?

The scar from the crescent Mastopexy is placed directly at the junction of the areola (pigmented skin) and non-pigmented skin. It heals leaving a scar that is barely visible in most people.

The full Mastopexy involves more incisions. The anchor shaped scar is normally the chosen incision line. However different doctors have different techniques. The scars are generally very well tolerated by patients as the scars are far less unsightly than the sagging breast. Over the course of 12 to -24 months the scars fade dramatically and in many individuals are not very noticeable. In some individuals the scars will always be somewhat visible, generally seen as a lighter area on the breast.

The Benelli leaves just a scar around the areolae (darker pigmented area). The Lollipop (or keyhole) leaves a scar around the areolae and straight down to the natural crease where your breast meets your rib cage.

All patients undergoing Mastopexy should be certain that they understand the incisions and resulting scars. When the patient knows ahead of time what to expect, it is most likely that the scars are not nearly as noticed as is the much improved beauty of the breast due to improvement of the shape and positioning of the nipple.

Is there a lot of swelling involved with Mastopexy?

Your surgeon should attempt to make your scars as inconspicuous as possible. However, you must realize that Mastopexy scars are extensive and permanent. The scars will be red and raised for several months -- gradually fading in color and flattening out.

Nipple sensation is generally preserved with this operation. The incidence of loss is usually less than 5%. In many individuals where there is significant ptosis, the sensation has diminished prior to the operation. In these individuals, nipple sensation will sometimes increase after the procedure. However, swelling may decrease sensitivity in the nipple area and/or the breast tissue from the swelling blocking the verves ability to send and receive messages from the brain.

When can I return to work?

You may not feel like doing much for a few days post-operatively. Although after the first three days you may be up and about, walking around thinking you are feeling fine. But in reality you are still able to take your pain medications and have the option of lying down if need be. If you are at work and must work for 8 hours - or even half of that - the option of lying down and popping a few pain medications is more than likely ruled out. Just be sure that no matter what you do, do not lift anything over your head (including your arms) for at least 10 days or until your doctor specifies otherwise.

No strenuous activities, including hard labor or exercise, for at least three weeks. In some cases, you are not allowed to have sexual relations until at least 7 days, post-operatively.

When will I be able to see the results?

Although the results are quite immediate you should not risk taking the bandages off to check. Your bandages will be removed in a few days at a post-operative visit and then you will switch to a soft support bra which will be worn for 21 days. Do not waiver from these instructions. It could risk improper healing and damage your sutures with the strain (weight) of your breast. After 21 days you will more than likely be able to go without a bra but this isn't advised. You should at least wear a bra either in the day or at night while you are sleeping. The breasts will eventually sag or lose their firmness once again as you age. They will sag at a faster rate if you choose to not wear a bra most of the time.

What are the risks of Mastopexy?

It is possible to have a negative reaction to the anesthesia, excessive bleeding, infection, hematoma and seroma. Of course, it is given that scars will be apparent that are associated with Mastopexy. Permanent loss of sensitivity in the nipple area and breast skin is possible. If you smoke your risks are increased not to mention that your scars will heal slower and possibly wider than a non-smoker's would.

A big fear is tissue necrosis (tissue death). I am serious, you do NOT want this. Tissue Necrosis happens when either you smoke and you have poor oxygen-tissue saturation or the surgeon did not use a pedicle to keep blood flowing to your nipple or other skin sections that were reattached. It also could be just bad healing. This is an issue and by far the most worrisome and dangerous so do all that you can to keep this from happening -- like stop smoking several weeks beforehand!

Infections, although rare can happen due to bacteria such as Staph, which naturally lives on your skin. That is why it is important to wash your breasts, neck and torso with an anti-bacterial soap like Hibiclens or even Dial anti-bacterial soap for several days up until your surgery. This can reduce the amount of Staph on your skin.

How long does a Mastopexy last?

Any surgery can not be considered permanent as far as aging, gravity and your personal bra-wearing habits go. Gravity and age will prevail and you will sag - period. Although we can attempt to slow its process by maintenance and healthy eating. Whatever the situation, a woman's breast tissue, in 95% of cases, will sag eventually. Regardless of having had Mastopexy, a breast will sag again. It may be years from now, but you may need an additional Mastopexy depending on your habits of bra wearing, this may be slower. It is supposed that a breast may sag again after 15 years with part time bra wearing, less than half that if a bra is hardly worn. If you have very thin skin, even less. Be safe and wear a bra.

How many techniques are there for breast reduction?

There is a manual technique where surgeons remove tissue after having opened the breast along the tissue lines where surface tissue will be removed as well and lifted.

There is the tumescent technique that is in all actuality, liposuction in a lesser form.

The liposuction technique can also be used with ultrasonic energy but has an increased chance of injury due to burns. Apparently the high frequency waves can over-excite the water molecules (or any fluid) causing them to boil beneath the skin as well as damaging superficial tissues as well. Unfortunately there is also the possibility that blind removal will accidentally disturb or remove milk ducts/glands in such a way that a patient's breast feeding chances are severely decreased.

Is breast reduction permanent?

Yes, Breast reduction is permanent. Although the remaining fat cells will swell and enlarge if you overeat and gain weight. Breast tissue will still swell and be tender to the touch when affected by natural or synthetic hormones. If you take hormone supplements it is quite possible to gain small amounts of breast tissue back. Although it may not look the same or be as much.

What does a typical breast reduction consultation entail?

Firstly, your doctor will discuss your goals with you and he will explain what can realistically be achieved. A surgeon should take into account what your hip size is. Your breasts may be a hindrance to you but removing too much will make your hips look large and give you a pear shape. Obviously you can request significant removal, just consider balance when determining your end size. Many women with large breasts just "want them out!" but may later regret having the majority of the breast volume removed. I am just suggesting thorough consideration before committing.

He or she will then show you photos of his work, you may also wish to show him photos that you have brought to the consultation of what you like and do not like. He or she should discuss the risks at length and the details that are associated with a breast reduction. There is no one size fits all technique when it comes to this procedure. It is all individual, just like you!

Protocol for a pre-operative appointment if you should choose to undergo a breast reduction:
Prior to surgery, a complete medical history is taken in order to evaluate the general health of the patient. The breasts themselves are then examined thoroughly to determine the most effective surgical approach. The surgeon will go over the anesthesia to be used, the procedure, what results might realistically be expected and possible risks and complications.

Mammograms or x-rays may be taken as well as pre-operative photographs. Preoperative instructions often include the elimination of certain drugs containing aspirin for several weeks before surgery in order to minimize the possibility of excess bleeding. Birth control and other estrogen containing hormones may also be discontinued temporarily (depending upon the individual). Antibiotics, pain relievers and other medications prescribed a few days prior to your surgery for your convenience as we want you to be completely prepared for your surgery with no excess worry.

How is breast reduction performed?

For the liposuction technique, small incisions are made within the natural fold underneath the breast or perhaps on the outer side as well. Sometimes a tumescent technique is used where a solution of saline (delivery and tumescent agent ), Lidocaine (pain reliever) and epinephrine (prohibits excessive bleeding and excess absorption of Lidocaine) are injected into the targeted area. This technique's purpose is to engorge the tissues with the solution for a firmer working area and the fat cells (which are softer) are suctioned out. The epinephrine prohibits bleeding during the operation and less blood is lost during the procedure.

There is a liposuction technique which involves ultrasonic energy waves. These ultrasonic waves excite the tissues' water molecules (fat molecules being the target) and literally melt the fat into a liquid for ease of removal by suction. Unfortunately, each patient's molecules may react differently or in the case of unskilled surgeons, may improperly handle the equipment resulting in severe burns.

There is the manual removal technique which is often incorporated into with a breast lift operation. With this technique there will be scars associated with the breast lift more than likely anchor shaped as extensive tissue will more than likely be removed and proper re-positioning and re-contouring of the breast will be performed.

In any case, the targeted breast tissue and fat is removed, sutures are sometimes used in the closure of incisions for the smaller, liposuction-assisted breast reduction and most definitely for the traditional breast reduction techniques. Then, a support garment or surgical bra is worn for proper, compact healing. A surgical or soft bra will be worn for several weeks both day and night.

Where are the incisions made?

The incisions are made within the natural folds under the breasts, around the areolae in a line from the crease to the areolae. Like a keyhole in many cases. The breast reduction procedure is not a minor one and scars should be expected. Unnecessary scarring is generally avoided although in techniques not using only the liposuction assisted method, scarring is more pronounced. Discuss with your doctor his or incision placement of choice and why?

What should I expect post-operatively?

The patient may be placed in two bras as well as an Ace bandage. In some cases you may remove the top bra only and rewrap the breasts with the Ace bandage the day after surgery. Some patients are told not remove the Ace bandage or bra for 3 days. Patients may choose to wear the Ace bandage for up to 10 days if they find it to provide added comfort. Patients are usually instructed to wear their surgical bra for 21 days both day and night. Please ask your own surgeon for specific instructions.

During recovery, the patient is carefully monitored and is allowed to be driven home a few hours later. Although, a surgeon should insist that you remain near the vicinity in case you experience complications.

Some patients are instructed to ice continuously for the first 48 to 72 hours. If this is the case, you will put an ice bag (or bags bags of frozen peas) over the breasts to maintain the coldness continuously. This will reduce any discomfort and swelling significantly. The pain connected with the procedure is minimal to moderate and is controlled with oral pain medication. The antibiotics that were prescribed will be taken for several days post-operatively to prevent infection. Instructions for the day and night after surgery include bed rest with limited activities. Your surgeon will determine when normal activities can be presumed at your post operative visits -- normally at 3 weeks. Strenuous activities and heavy lifting must be avoided for several weeks.

You should notice a gradual reduction in discomfort. Sometimes swelling will increase over the first three days. Fever greater than 100.5 should be reported to your surgeon. Marked increases in tenderness after 48 hours along with redness may indicate an infection. This should be reported immediately.

You may only sponge bath for the first 3 days after surgery as you must not get the bandage wet. You can remove the bra after 8 days but only to put on a fresh one. Replace the bra quickly after washing. After 14 days a normal shower may be take. Be sure to replace the bra immediately after showering or bathing.

There will be swelling and your doctor may prescribe a pharmaceutical grade Arnica montana for the relief of this. There may be some bruising but the Arnica montana will help alleviate some of this.

You should be wearing your bra 24 hours a day for the first 3 weeks. After the 21 day period, the bra should be worn at least during the day time for 6 months. The tapes that are over the suture lines should not be removed as your surgeon will remove them in approximately 10-15 days.

Complications and slow healing are rare, however there are certain inherent risks connected with reduction mammoplasty which will be thoroughly discussed at your consultation. The risks and instances of slow healing are more significant in smokers.

What Causes Frown Lines & Crow's Feet?

Those unwanted frown lines and crow's feet are what doctors refer to as "dynamic" wrinkles, meaning that they are caused by the repetitive movement of an underlying muscle. As we age our skin is less tight, and this repetitive movement caused by squinting, worrying, etc., eventually causes our skin to crease or wrinkle.

Is it quite painful? Is there much bruising?

It takes about a week and a half for most of the swelling to subside. There may be bruising with average cases, although it should be looked upon as individual. Some are prone to bruising more than others. Some doctors suggest a pharmaceutical grade Arnica montana product called SinEcch and a topical ointment as well. Some surgeons suggest Bromelain or drinking pineapple juice starting 3 days pre-operative. These products are thought to decrease both bruising and swelling in all procedures and in most cases have shown a significant decrease in both complaints. You should take your prescribed pain medication to alleviate any pain or discomfort that you may experience. Although if you feel as if your pain is severe do not hesitate to call your surgeon or the staff member on call.

How Does BOTOX® Reduce The Signs Of Aging?

BOTOX® is a purified form of the botulinum toxin. It is injected in miniscule amounts into the appropriate muscle causing the muscle to relax and thus diminish or eliminate the dynamic line or furrow. BOTOX® has been used for over ten years to treat ophthalmological disorders, and is fast becoming the chosen non-surgical treatment to reverse signs of aging. After treatment, a patient treated with BOTOX® can still frown and smile, but the expression wrinkles around the eyes and forehead are diminished when they do. Normal facial expression is unaffected. Correction with BOTOX® is very natural, and most patients treated feel that they have a more wide-eyed, rested and less angry look.

When will I be able to return to work?

Most patients return to work within 2 weeks. Although some patients have returned just after 5 days. It is highly individual.The discomfort is more than likely the main reason people tend to take off work. The bruising, may remain after 3 weeks. Still, you should not bend over, lift your arms over your head or exercise until well after 3 weeks post-op.

When will I be able to see the results?

You should notice the difference in breast volume immediately. For some patients, if the procedure was due to back pain associated with very large breasts, the pain relief is usually immediate. After the swelling subsides you will begin to notice a difference in the compact appearance of your tissues.

What Areas Can Be Treated With BOTOX®?

Most commonly BOTOX® is used around the eyes (crow's feet) and on the forehead (frown lines) to reduce dynamic lines and furrows. It can also be used to treat prominent neck bands or cords. Although great results are obtained on the upper face, we have also seen success after the treatment of upper lips, marionette lines and chin rippling. BOTOX® injections are also highly successful for the treatment of excess sweating of the palms, soles and armpits.

What are the risks of breast reduction?

There are more risks with this operation due to the fat and its surrounding tissues becoming necrotic (dead tissue). If the fat becomes necrotic from lack of blood supply, the fat tends to turn orange-ish clear and drain from the incision. If the tissue becomes necrotic, that's a whole other ballgame! You must have the tissue removed before a major infection develops, possibly causing gangrene. If anything happens regarding tissue necrosis or compromised vascularity please research Hyperbaric Oxygen Therapy (HBOT) it could save your breasts AND your life. I have a separate section on this.

Even with the ultrasonic technique, patients have been known to receive actual burns from the ultrasonic technique. The fat is actually melted within the body by 'exciting' the fat molecules with high frequency radio waves and is suctioned out. There may be asymmetry, hyper-pigmentation (permanent dark spots) from the bruising. Major blood loss is a factor is some cases. As is hematoma and infection. Unfortunately in most breast reductions, breast feeding will become a memory for any future children. Thankfully there may be newer techniques which may prohibit this type of loss. There is also the risk of loss of blood supply to the treatment area and permanent numbness due to nerve damage.

Another risk of breast reduction is pulmonary Thromboemboli, although not as high of a risk as it is with liposuction-assisted reductions or when liposuction is performed in combination with breast reduction. A thromboebolus is a blood clot and this blood clot can break free and travel to the lungs resulting in pulmonary Thromboemboli. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma -- leading to the loss of oxygen rich blood to the brain. Pulmonary Thromboemboli can happen within three (3) weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. However, pulmonary Thromboemboli can occur suddenly, without warning. Most patients with P.E. collapse and begin rapid deterioration after attempting to climb a flight of stairs.

How Long Does BOTOX® Correction Last?

BOTOX® correction lasts an average of four months. After repeated injections the results may be even longer lasting.

What Can I Expect From The Procedure?

BOTOX® treatments are merely a simple injection. Most describe the injection sensation as feeling like a bug bite. The treatment is performed literally in a matter of minutes. No specific care is needed after the treatment.

Are There Any Side Effects?

The most common side effect of BOTOX® treatment is a temporary bruising at the injection site. This generally goes away within a couple of days, and can be covered up with makeup. In rare cases the BOTOX® can travel, causing a droop in an eyelid. The effects are completely temporary.

How Soon After Treatment Will I See Results?

The effects of BOTOX® become apparent in the first three to five days after treatment.

Am I a candidate for a Face Lift?

If you feel as if your skin is starting to sag around the jowls, the forehead and generally "all over," if you look tired and physically exhausted and you, in fact, are NOT. Perhaps you are feeling as if your skin is starting to become aged looking and are searching for a way to restore your appearance to its younger looking state. Then, a Face Lift is one of the options that you can take. If it is just the sagging on the forehead or eyebrows, then an endoscopic brow lift might be best for you. Full face lifts are generally saved for those of us who are more "mature." However, younger patients are seeking mid and lower face lifts today.

Is BOTOX® Safe?

Yes, BOTOX® is safe. It has been used for over ten years to treat ophthalmological and neurological disorders.

What is a Face Lift?

The Face Lift is a cosmetic surgery procedure designed to improve the signs of the aging tightening the muscles beneath the skin of the neck, tightening the sagging skin itself, removing excess fat and overall improving the appearance; rejuvenating the face to its former youthful appearance. Post-operative patients agree that a face lift seems to take 10 years off of their appearance, easy.

Can BOTOX® Be Combined With Other Facial Rejuvenation Procedures?

When is a Face Lift usually performed?

There is no usual age that a patient requests a face lift. It can be from 30's to 80's. Although, a brow lift can work wonders for younger patients whose only complaint is horizontal lines on the forehead and sagging brows or slightly hooded eyes. Brow lifts are often requested in the late 20's-early 30's category and up. It is quite possible that a brow lift is all that is needed.

However, A face lift can produce better results in those who are more mature or need extensive lifting and tightening or rejuvenation. Seeking an entire lifting of the facial skin and/or structure to produce a more youthful and alert appearance. You can discuss your available options with your surgeon to determine what is best for your individual case.

How Do I Find Out If I Am A Candidate For BOTOX®?

Our staff will be happy to discuss BOTOX® treatments with you.

What does a typical Face Lift consultation entail?

First off, your doctor will discuss your goals with you and he will explain what can be achieved realistically. Some patients may require a deep plane face lift involving the tightening of the inner muscular structure of the face. You should bring photos of yourself at an earlier age to determine your original facial look so the effect can be a natural one. Most patients don't want to wake up and not look like yourself once you heal. You just want to try and achieve a more 'pulled together' look; an attractive you at a younger age. Although, some of you may want to change the structure of your face altogether. Discuss with your surgeon the goals and general result you would like to achieve.

How is Face Lift performed?

The Face Lift operation is most frequently performed using General or Light Sleep Anesthesia. After your arrival additional medications are given intravenously which induce a profound state of relaxation. Patients usually sleep during the operation. Much of the time patients have very little memory of the operation itself. After this state is achieved then medicines are given to produce numbness of the surgical area. This type of anesthesia is most frequently preferred by patients. It causes almost no recovery necessary from the anesthetics themselves unlike general anesthesia which may produce nausea after the surgery. It also carries less risk of complications. If general anesthesia is preferred, this may also be used.

This procedure takes about 2 to 6 hours to perform. It may take longer if you choose to have a neck lift as well. For procedures 3 hours or longer, many surgeons advise General anesthesia. Depending upon your facial structure the incisions will be placed as inconspicuously as possible above the hairline. Some doctors still cut at the hairline so ask your doctor which incisions he prefers. The incisions usually begin above the hairline, at the temples, continuing in a natural line in front of the ear. Some doctors can make the incisions with the cartilage just in the front-inside part of the ear, ending behind the earlobe and lower region of the scalp.

The skin is separated from the fat and muscle below it. If the neck lift is being performed with the face lift, a small incision is placed inconspicuously underneath the chin and excess fat may removed by either trimming it by hand or by facial liposuction. More than likely, your surgeon will use the facial liposuction technique. The underlying muscle and fascia are tightened and the skin itself is pulled back, trimmed and sutured into place. Sometimes surgical staples are used within the scalp. The surgeon may place a small drain tube behind your ears for excess fluid and blood drainage

What are the different techniques in performing a Face Lift?

There are older-style or standard "skin-only" face lifts that don't seem to last as long nor improve the appearance as much as a deep plane or 2 layer lift will. The deeper lifts involve lifting the SMAS (sub-muscular aponeurotic system - the facial muscles) which tightens the jowls, cheeks and the face in general.

What should I expect post-operatively?

Although, there is normally no extensive pain related to the facelift operation, pain medication is prescribed before hand. You may feel a degree of numbness that will normally disappear within a 1-3 months.

Don't be alarmed at the presence of bruising and swelling. This is very normal and you must realize that your skin and underlying tissues have been stretched, pulled and cut. The swelling will begin to disappear within the first couple of weeks. Many patients return to work with the help of camouflaging cosmetics at about 10 days post-op.

Things to be alarmed about that are not normal:

Temperature elevation greater than 101 degrees

Sudden swelling or sudden discoloration

Hemorrhage

Increasing redness and tenderness of the wound edges indicating infection

Allergic reaction to drugs

When will the sutures be taken out and does this hurt?

The drain tube, if used, will be removed in approximately 2 to 3 days. Although your bandages may not be removed until about day 5. Your face will swell, and it appears at it's worse at day three. Your stitches may be removed the same day as your bandages; if surgical staples were used within the scalp area, they may be removed in 7 to 10 days.

Will there be scarring? If so where will the scars be located?

Some scarring is necessary, usually hidden in the hairline, behind the ears or under the jaw line. The surgery is individual to your needs and your doctor can discuss with you the techniques that he uses. Endoscopic procedures involve tiny scars hidden in inconspicuous areas.

Is there a lot of swelling involved with a Face Lift?

You can expect considerable swelling at day three. Your face may look quite normal when you get home but the next day and the day after it will begin to swell. You may not recognize yourself, do not be alarmed, this will subside. In two weeks you will be delighted in the changes.

How long should I expect to be away from work?

You can expect to resume regular activities in about 3 weeks. It really is individual but the swelling is quite pronounced involving a facelift. There is bruising and of course a support will be worn at night to alleviate tissue stress and to support the healing tissues correctly. I wouldn't make any plans to attend any weddings or other functions where you will be high profile for at least 6 weeks.

When will I be able to see the results?

Having a facelift does not halt the effects of aging. You may choose to undergo a facelift again within 10 to 12 years. You will notice the tightening in your facial skin and muscle structure as soon as your swelling subsides. You do not want a severe "pulled back" look that is often seen in bad facelifts. This result is not normal and looks very done. Your face lift should lend alertness and vitality as in your youth. You will not look twenty or even thirty if you have a face lift at age 50. That is not the intention. However, you will agree that your appearance resembles a younger more relaxed version of you.

What are the risks of Face Lift?

There is a chance of hematoma (blood clots), numbness from nerve damage and hyperpigmentation (permanent discolorations) caused by the bruising. There may be asymmetry and/or undesired results resulting from a face lift. Possible infections may arise and scarring can be apparent depending on the incision placement. There can be necrosis of the facial fat and tissues resulting in tissue removal. If performed by an unskilled surgeon, it is very possible to have your skin pulled too tight and result in a very windswept look.

What are follicular unit grafts and micro-grafts?

A follicular unit is a group of hair as it naturally occurs. Individual follicular units are very small and grow in an irregular pattern. Follicular units are usually preserved in their natural composition. This is important because it maximizes the supply of donor hair and contributes to the finest, most natural looking result. A micro-graft is a graft with 1, 2 or 3 hairs. The goal of any hair transplant procedure is to provide the patient with a very natural look, maintaining virtually undetectable results and optimal density without compromising the donor area. Multiple techniques can be effective but it is the responsibility of the surgeon to select the best method for obtaining a patient's specific goal.

How long does a face lift last?

It is hard to say, but normally a face lift can last about 10 years. Of course, every case is individual and you will look younger regardless. This procedure can not stop you from aging but can lessen the appearance of your general sagginess and/or lines. Patients have shown up to a 7 to 12 year waiting period before choosing to undergo additional rejuvenation procedures.

Am I a candidate for hair transplantation?

A consultant can educate you on the causes of hair loss and available treatment options. After your evaluation by a doctor, a final determination will be made as to whether you are a candidate for the procedure. They will analyze your individual hair loss, discuss expectations and outline your options. Factors that determine candidacy for the procedure include the number of grafts that are necessary to produce the results your desire, availability and density of donor hair, hair color, skin color, hair texture, and potential future hair loss.

Has hair transplantation been proven to work?

Hair transplantation has been successfully performed for over 40 years. Recent advances in the use of follicular unit grafts have dramatically improved the results of hair restoration surgery. Transplanted hair looks as natural as the rest of your hair because it is your naturally growing hair. One of the exciting and unique benefits of transplanted hair is that it will grow for the rest of your life.

If I am unhappy with a transplant performed by another doctor, can Bumrungrad International correct the problem?

Performing an average of 40 to 60 cases of corrective hair restoration surgery each month, Bumrungrad Hospital has developed methods by which a poor hair transplant can be modified into a desirable result.

Can I afford hair transplantation?

The real question is - can you afford not to have a hair transplant? Hair restoration is more affordable today than ever. After a thorough examination of your hair loss and discussion of your expectations, we will be able to provide a realistic estimate of the time and expense necessary to achieve your goal. The fees charged by many hair transplant surgeons may cause a great deal of confusion. Some surgeons charge by the graft, others by the hair, and still others by the session. The important consideration for any patient is to receive the natural coverage and density desired within the budget allowed. MHR patients report their results are unparalleled and claim, "It was the best money I ever spent." A hair transplant is of value only if it satisfies the patient. Although expense is an important consideration, it should not be the only consideration. Unlike other methods of hair loss treatment, the cost of each surgical procedure is a one-time expense. We tailor the procedure and payment to each individual's circumstances and budget.

At what age should I start hair transplantation?

Hair loss is a problem which persists throughout life. We encourage you to address the issue early... before it becomes more visible. An earlier start will allow your surgeon to camouflage the work while the transplanted hair grows in gradually and unnoticed. There are no age limits (our patients range from 21-80 years old). You don't have to wait until you stop losing hair to start. There is no magical age where hair loss stops. Doctors take into account your future hair loss, and their surgical plan makes sure you will look natural along the way. If you have been waiting for hair transplantation surgical techniques to be perfected, that time has arrived. Start counting your new growing hairs instead of those falling out.

Since Propecia is now available, doesn’t that mean hair transplantation is a thing of the past?

While Propecia and Rogaine have been proven to regrow hair, they will not grow all your hair back. Their greatest benefit seems to be in slowing down hair loss. Propecia and Rogaine can be part of a very effective hair restoration plan.

It is hard to say, but normally a face lift can last about 10 years. Of course, every case is individual and you will look younger regardless. This procedure can not stop you from aging but can lessen the appearance of your general sagginess and/or lines.

Originally cheek (malar) implants were used for reconstruction for birth defects and trauma related incidents. Now, they are being applied aesthetically to enhance a person's cheeks or to create symmetry within the facial structure. With cheek implants, the flatter face is transformed into one with chiseled features that can be very aesthetically pleasing.

There are also injectable options that do not create a bony structure but do augment the cheek area. Injectable fillers are often injected deep within the dermis and move when the skin and muscle moves. Permanent injectable fillers can not essentially be removed from the dermis without tissue excision if an infection, inflammation or discontent arises, Silicone and other implants, can be.

Doesn't removing hair from the donor area on the back of my head leave a big gap?

The scalp is very elastic. When the donor strip of hair is removed, the scalp on both sides is just pulled together and sutured. The only evidence of surgery is a thin line hidden under the hair that grows vertically on the back of the head.

What are implants made from?

They are normally made from hard Silicone, however they can also be made from:

Silastic, a solid, flexible plastic

Hydroxyapatite, a ceramic that resembles sea coral

Polyethylene, a plastic that resembles sea coral

Gore-Tex, the same material used in high-quality raincoats

Cadaver bone, bone from deceased human donor

What does a typical cheek augmentation consultation entail?

Firstly, your doctor will discuss your goals with you and he or she will explain what can be achieved realistically. The usual goal is to augment a lacking cheekbone structure. Although, some of you may want to rejuvenate your face, others may change the structure of your face dramatically for that cat walk model cheek bone look. Discuss with your surgeon the goals and general result you would like to achieve. It is all individual.

Your doctor will take into account your facial dimensions and natural face shape. There are many types of malar and submalar implants. The placement as well as the size of the cheek implants will be determined by you and your doctor. Don't be afraid to speak your mind during this time. Computer imaging is helpful in conveying your desires and expectations but should not be relied upon.

What are the reasons for female hair loss?

Normally, hair loss is caused by heredity, hormones and age. Genetic makeup determines if hair follicles are sensitive to the hormone dihydrotestosterone (DHT) and other hormones, causing them to shrink. This "shrinkage" results in overall thinning with time. In addition, the aging process can weaken the follicle and consequently the hair shaft. This causes thinning and balding - permanent hair loss.

How is cheek augmentation surgery performed?

The cheek augmentation surgery is most frequently performed using Light Sleep or General Anesthesia. Light Sleep Anesthesia is the use of medicines to induce a state of relaxation and a light sleep. General is more of a deep sleep and can either be in gaseous state (intubation) or intravenous.

This procedure takes from 1 to 1 and 1/2 hours to perform. It may take longer if you choose to have chin and cheek implants as well. Depending upon your facial structure the incisions will be placed as inconspicuously as possible within the hairline or within the mouth for cheek implants. Some doctors even place the incisions inside the lower eyelid area. The risk of infection is higher if an incision is placed within the mouth area but with proper post-operative care this risk can be decreased.

Is Rogaine® effective?

The hormone DHT and other hormones are the cause of hair loss in genetically susceptible women. Minoxidil, which is marketed under the name Rogaine®, was the first FDA-approved treatment for slowing hair loss in women. This over-the-counter, topical solution must be applied directly to balding areas. Although it is used to combat hair loss in its early stages, Rogaine® is sometimes used during the hair transplant process to enhance initial, new hair growth.

What are the different techniques in performing a Cheek augmentation?

There may be surgeons who only wish to use a certain implant type or a certain incision. Surgeons should give you a choice, as the updated techniques are less scarring than the previous ones. The doctor may prefer an intra-oral approach where the only incisions are placed within the mouth area. No visible scars are made with the inta-oral incisions, plus they heal much faster. However, oral techniques sometimes are plagued by a higher rate of infection. Especially in those with problems with apparent plaque build up or poor dental hygiene.

Check with your doctor on the preferred technique that he utilizes. He may very well prefer the traditional methods out of not being aware of the newer ones or he may very well offer only the newer ones, with the thought that the older techniques are simply, out of date. This subject varies with surgeon to surgeon.

Is it common for women to get hair transplantation to cover face-lift and other cosmetic scarring?

Yes. Hair transplantation can be quite effective at concealing visible scars that result from a number of different procedures including face-lifts, brow- lifts, and even scars resulting from major surgery of the head. Modern micro-grafting techniques allow the surgeon to place grafts in front of, behind, and even within the substance of the scar itself.

I am a woman, should I see my doctor prior to seeking hair transplantation?

Because hair loss in women can be caused by a number of factors other than androgenetic alopecia, which can ultimately affect the new grafted hair, it is recommended to see your physician for a complete diagnosis before seeking hair transplantation. It is very important to seek out a dermatologist or hair restoration surgeon who is sensitive to this need for a clear diagnosis, as this is important to the development of a proper treatment plan.

What should I expect post-operatively?

Although, there is normally no extensive pain related to cheek implantation, pain medication is prescribed beforehand. You may feel a degree of numbness that will normally disappear within 1 to 3 months. You may continue to wear a support brace while you sleep to allow your tissues and implant to heal in the desired position and prevent shifting in the first few weeks.

Don't be alarmed at the presence of bruising and swelling. The swelling will begin to disappear within the first 5 to 7 days. Many patients return to work with the help of camouflaging cosmetics at about 5 days post-op. The swelling resembles inflammation of wisdom teeth or their removal and sometimes this excuse is used at the office. Although please realize that the swelling may be apparent for months and the defined, chiseled look that you so desire may not become evident for quite a while.

Things to be alarmed about that are not normal:

Temperature elevation greater than 101 degrees

Sudden swelling or sudden discoloration

Hemorrhage

Increasing redness and tenderness of the wound edges indicating infection

Allergic reaction to drugs

Shifting of the implant

When will the sutures be taken out and does this hurt?

The sutures, if any, will be removed in approximately 3 to 5 days. Your face will be swollen for the first few days -- this is normal. The suture removal should not hurt extensively although your surgeon may attempt to feel the implant through your facial tissues and this may hurt a little. The swelling should very much dissipate after the first two weeks but still may have bouts of swelling in the mornings, or after you wake up.

Will there be scarring? If so where will the scars be located?

This depends on the incision choice by you and your surgeon. It is quite possible to have your implants inserted with no visible scars, whatsoever. Ask your doctor if he is familiar with the intra-oral incision and what he thinks about it. Ask him if he is aware of the inner lower eyelid incision for cheek implants which results in NO visible scars and any infection is a rarity. Although ectropion is at risk here. Ectropion is a condition where your lower lids are pull down or gape. If you should develop ectropion, further surgery will more than likely be needed to correct it. Which could lead to more risks and more cost to you, the patient.

What sort of dietary restrictions will my child need to follow before and after the surgery?

The medical staff will give you detailed instructions outlining what your child will and will not be able to eat before and after the surgery. The factors vary greatly depending on local factors.

Is there a lot of swelling involved with cheek implants?

There will be some considerable swelling associated with the trauma to the tissues, especially if there were screws involved. Bone trauma may hurt a little more than just tissue trauma so take this into account when you decide on the technique. You may feel sensations of warmth or coldness regardless if screws are used. Your mouth may be sore from the intra-oral placement and you may need to stay on a soft foods, and liquid diet because of it -- although, this is hardly enough pain to dissuade you from making an "incision decision." Be advised that you will look like a chipmunk for a while and that the chiseled definition will not be apparent for a few months. Please go into this surgery well-informed because many re-operations or removals are due to patients not being able to handle the swelling.

How long will my child be in the hospital after surgery?

If your child is having an outpatient procedure, he or she will probably be in and out of the hospital in the same day.

For inpatient procedures, the length of stay varies, depending on the procedure and your child's rate of recovery. If your child has major abdominal or thoracic surgery, he/she will probably be in the hospital for five to seven days. If the doctors' and nurses' postoperative instructions are followed closely, the child will likely be able to return home sooner.

Length of stay often varies from child to child, and depends upon the exact procedure performed.

How long is the "down time" for this procedure; how long should I expect to be out of work?

You can expect to resume regular activities in about 1 to 2 weeks. Although exercising should be be reserved for after the third week. It really is individual but the swelling can be pronounced involving cheek augmentation. There is bruising and of course a support will be worn at night to alleviate tissue stress and to support the healing tissues correctly. I wouldn't make any plans to attend any weddings or other functions where you will be high profile for at least 4 weeks. Most patients return to work within a week but two weeks is nice to take off during this time to allow bruising to dissipate. Plus if you have to talk a lot you may wish to stay home for about 2 weeks. Or return to work when you feel up to it. If you have a very laborious job, it is best to wait 2 to 3 weeks.

How much should I tell my child before hand about surgery?

It is important that you be honest with your child. Let your child know what's going to happen - be careful not to use words that will make the surgery sound scary. Remember to let your child know you will be nearby throughout the entire hospital visit.

When will I be able to see the results?

The results are immediate, although you may think that the implants are too big at first glance. Give your mind time to recognize the difference in swelling and augmentation. Most patients are very satisfied with the augmentation results as long as they are aware of what to expect beforehand.

What are the risks of cheek augmentation?

There is a chance of hematoma (blood clots), numbness from nerve damage and hyperpigmentation (permanent discolorations) caused by the bruising -- althoughmany patients do not bruise badly at all. There is the risk of implant shifting which results in additional surgery to reposition the implant. There is the chance of your disapproval which may result in a re-do or removal. There is also a chance of asymmetry from tissues healing differently.

How long do cheek implants last?

The silicone cheek implants are made to last your lifetime. More than likely you will take them with you to the grave. Especially if the implants are the harder variety and screwed into place, your risk of shifting is very minor. Although anything having to do with inserting metal into bone run the risks of infection and bone deterioration. Do be advised though pressure of the implant can cause bone resorption under the implant, especially with silicone implants. Then again, everything is dependent upon the individual and as you should know there is no "never" or "definite" in medical science.

Can my child have two different procedures done at the same time?

It is possible for more than one procedure to be accomplished at the same time, as long as it is considered to be safe for the child.

What is a hernia? Can the operation to fix a hernia make my son sterile?

An inguinal hernia is an opening in the muscle of the groin in which a portion of the intestine (or ovary, in girls), can pass through.

It may be large or small, and usually appears as a lump or swelling in the groin or scrotum in boys, or in the labia in girls.

An umbilical hernia develops when the muscles in the abdomen, around the belly button, do not fully close before birth, and some intestine protrudes into the opening.

The operation is a perfectly safe procedure and will not cause a male to become sterile. Fixing a hernia can prevent damage to the testicle.

When can my child resume full activity?

This depends primarily on the procedure being performed. Be aware that recovery timelines can vary from child to child.

Your child's doctor will be able to give you specific information about when your child can resume normal activity.

How soon after surgery may I see my child?

You may see your child when the medical team determines that he is in a stable condition in the recovery room. This is normally 30 to 45 minutes after surgery, which is usually when the child is just becoming aware of where he or she is.

What does a typical Brow Lift consultation entail?

Your surgeon will go over your options that can realistically attain your goals. You will discuss the risks and complications as well as anesthesia choices and fees. As well as what to expect post-operatively. This is the time where you can ask questions regarding your concerns and determine if this surgeon is for you. Do not be afraid to inquire about anything.

How is Brow Lift performed?

After you are anesthetized or sedated, your surgeon will determine the area which need to be excised and where the best incision placements would be for your particular needs. You will have this skin dissected and your surgeon will move and suture your muscle or skin, depending. Or he or she may excise or "clip" your corrugator muscle to prohibit or hinder you from frowning in the future. After the internal work has been done your incisions will be sutured and a pressure dressing will be applied.

What should I expect post-operatively?

Expect to be swollen, tender and possibly bruised. This is very normal so do not be alarmed at the presence of any of the above. If you are in pain, take your prescribed medications and do not forget to take your antibiotics and apply your eye salves if instructed. You will be groggy from the anesthetic so this is a good thing, do not fight it. This helps you rest and adjust to your healing period without pain or memory of pain.

When will the stitches be removed and does this hurt?

The sutures and/or staples will be removed in a week to 10 days. It may hurt a little but your surgeon can give you injections of a Lidocaine (a pain reliever) in case your staples are difficult or painful to remove.

What causes congenital hand differences?

There are many factors that can affect the development of the human hand. Generally it is caused by a spontaneous alteration during development and is not from any outside factor or event of pregnancy.

When will I be able to see the results?

The results are immediate but you will be swollen, remember to be patient during the healing period and the full results should be visible in a few months. You may also think that your brows are too high, this is normal and will relax. Any numbness along the incisions should subside by 6 months but may remain indefinitely in some patients. Remember that as each day goes on you will be that much closer to your final result -- so be patient.

When should my child be seen for a hand problem?

The sooner the better, but there is no emergency. It is best for the child to be seen early so physicians can follow growth and progress.

What are the risks of Brow Lift?

There is a chance of hematoma (blood clots), numbness from nerve damage and hyperpigmentation (permanent discolorations) caused by the bruising. There may be asymmetry and/or undesired results resulting from your brow lift. Possible infections may arise and scarring can be apparent depending on the incision placement. There can be necrosis of the tissues at the incision lines, resulting in additional tissue removal. If performed by an unskilled surgeon, it is very possible to have your skin pulled too tight and result in a very "surprised" look. Although you may look this way at first -- it should relax.

Are the results permanent?

You may say that the results are semi-permanent. We are going to continue to age and our brows will droop -- it is a fact of life, unfortunately. Of course the endoscopic techniques may not last nearly as long as the coronal lift but they are by far less invasive.

Do all hand problems require surgery?

No, most hand problems are treated with nonoperative means. A minority of these difficulties actually require surgical intervention.

If surgery is required, when is the appropriate time?

Most hand surgeries are not done during the newborn period. We most often wait until the child is 12 to 18 months old, at the youngest.

Do stitches have to be removed in the office and is it painful?

No. For young children we use absorbable stitches that do not have to be removed.

Is this a dangerous condition?

No, not really. But if the gynecomastia is really significant, teens will sometimes try to avoid situations where they have to take their shirts off. They may come off as being shy, they may be socially isolated--avoid sports and girls--just because they're embarrassed about the appearance of their chest.

What is gynecomastia?

Literally, the term "gynecomastia" refers to female-like breasts. Of course, this is in guys--female-like breasts in women are desirable. But in guys they're not welcome.

What are nonsurgical ways to treat hand problems?

There are several nonsurgical treatment methods including therapy, medicine, splinting, casting, gentle stretching, and observation.

It can, but of course that would be an extreme case. More typically, it starts as a little lump under the nipple, usually during puberty. The lump usually goes away with time, but not in all cases. Sometimes it gets bigger, causing the nipple to stick out. In a boy who is a little overweight, the chest might really start to look more like his sister's chest with early breast development. Some kids can even squeeze a little fluid out of the nipple. It's a pretty frightening experience for an adolescent, so lots of guys just ignore it, hoping it will go away--unless their parents push them into seeing their doctor.

Will my child have a prolonged hospital stay after surgery?

No. Most hand surgeries are done as outpatient surgery and the child is allowed to go home the same day.

Is gynecomastia common?

A number of studies have looked at the frequency of gynecomastia in the general population, and the incidence may be as high as 60 - 70%. What is found is that it occurs most commonly in three age groups: Newborns, adolescents, and older men.

Ligaments and Tendons in Rheumatoid Arthritis - Can surgery alleviate the pain associated with damage to ligaments and tendons in the wrist and hands as a result of rheumatoid arthritis?

The hand pain in rheumatoid arthritis (RA) may originate from a large variety of causes, chief amongst them are the inflammation of the synovial membranes. Synovium is specialised tissue that allows gliding to occur and secretes the lubricant and nutrient synovial fluid essential to normal joint function and the function of some tendons. In rheumatoid arthritis this tissue becomes inflamed and instead contributes to the destruction of the joint and its adjacent ligaments (which are the stays that effectively constrain the joint and render it stable but mobile). As the joints and ligaments decay, so they may become unstable and deviate or adopt abnormal attitudes or positions, putting increased strain on the remaining ligaments. Such inflamed and swollen joints are painful in their own right, and some pain may arise from the joint surfaces or from the capsule that surrounds the joint including the ligaments that bear abnormal strains.

Surgery in this condition has several aims. Some doctors believe that in particular circumstances there is a place for “prophylactic” or preventative surgery in which the destructive diseased synovium is removed to prevent its adverse effect on adjacent tissues. Further, some feel that when the joints begin to deviate, corrective surgery to the ligaments and soft tissues (as opposed to bone) may allow realignment of the joint surfaces and prevent the erosion of those surfaces that comes from chronic malalignment. This surgery is particularly appropriate for the metacarpophalangeal joints (at the junction between fingers and palm) which commonly deviate away from the thumb side of the hand, sometimes well before the joints themselves require replacement.

It should however be borne in mind that other causes of pain occur in rheumatoid arthritis in the hand, and important amongst these are nerve compression pains from swelling of adjacent joints or tendons, and subsequent compression of the nearby nerves. A good example of this is rheumatoid arthritis associated carpal tunnel syndrome. Any one suffering from rheumatoid arthritis with any new type of hand pain should be evaluated by a hand specialist or rheumatologist where possible, and regular checks by a rheumatologist or hand surgeon are sensible; in this condition. The individual indications for surgery for pain may then be discussed in detail.

Why does gynecomastia happen only to males at certain age groups?

The bottom line with gynecomastia is that it occurs due to an abnormality in the ratio of testosterone to estrogens in the body. When this ratio is low, the estrogen effect is stronger and stimulates the growth of the tissue around the breast. The testosterone which is most important is that which is not bound to protein in the blood, in other words, the free serum testosterone. This has been found to be lower in boys with gynecomastia compared to those without, while all the other hormone levels were about the same.

If this is caused by estrogens, does the tissue actually look like women's breast tissue?

It does to a certain extent, in that it is made up of ducts and fat and other elements which are found in women's breasts. At the same time, it looks different to a pathologist who is looking at the tissue under a microscope--it doesn't really form glands to make milk as it does in women.

Now, why would a pathologist look at the tissue--is this a type of cancer?

No, gynecomastia is not cancer. It is a benign disease, even though its quite depressing for men who get it.

Could it be cancer?

A lump in the breast should always cause some concern, though breast cancer in men is very unusual--less than 1%, and this is generally in older men. Gynecomastia often occurs on both sides, so if a breast mass occurs on only one side, it may be more suspicious for cancer. It would be extremely unusual to see male breast cancer on both sides at the same time. Sometimes a patient's history may give a clue as to whether or not the lump could be cancer. In other cases, a mammogram or ultrasound may be required. Sometimes a biopsy of the tissue must be done to be sure it isn't cancer.

Is there any way to predict who will get gynecomastia and who won't?

Unfortunately, no.

Which is better--excision or liposuction?

Liposuction is a great tool when the condition is mostly caused by fatty tissue, because this is easily removed this way. In steroid related gynecomastia, the tissue under the nipple can be very dense, and I find that this must be cut out.

Which is better--excision or liposuction?

Liposuction is a great tool when the condition is mostly caused by fatty tissue, because this is easily removed this way. In steroid related gynecomastia, the tissue under the nipple can be very dense, and I find that this must be cut out.

Replacement finger joints MCP/PIP - After surgery when can full function be expected. What are my new joints made of?

The MCP (metacarpophalangeal) joints are the knuckle joints where the finger joins the palm. The PIP joints (proximal interphalangeal) are the middle joints of the fingers.

MCP replacement with prostheses is most commonly undertaken for advanced rheumatoid arthritic change with deviation and loss of function at these joints. By far the commonest replacement joint is made from Silicone rubber. Because of its structure it does not accurately replicate the biomechanics of the joint it replaces, and so full function is never restored. In addition it is made of a friable material and for this reason it is subject to attritional wear. Most surgeons therefore use it almost exclusively in the low demand low load hands of rheumatoid patients where it can be very successful indeed.

In addition the joint has no inherent lateral stability, which is not a problem in the MCP because the adjacent joints bolster it, but in the PIP it can pose problems resisting lateral stress.

Many of us believe that the ideal range of motion after an MCP joint replacement is about 30 to 40 degrees, compared with 90 degrees in the unaffected hand.

How visible are the scars after excision

Usually, they're barely perceptible.

What are other risks of the surgery?

Problems which can occur include bleeding or hematoma formation, which can require a second operation for drainage of the collection of blood. This is more common in steroid users due to the high degree of vascularity of the chest wall. Infections are very unusual. The nipple sensation is usually altered after the operation, and in rare instances the nipple loses it's blood supply and dies. In this case, it has to be removed and replaced as a skin graft, but it doesn't look great when this is done. Depressions or contour irregularities can also occur.

Supernumery digits - What exactly causes this abnormality and is it common?

This condition describes extra digits on the little finger side of the hand, or ulnar border.

The digits are usually attached by a slight stalk, rather than truly articulating with the rest of the skeleton: hence the ease of removal.

The condition can have a hereditary element.

How long does the surgery last?

The surgery takes about one and a half hours.

Missing Digits - What causes this and is there anything that can be done?

There are numerous causes of this problem.

It is that this is very unlikely to represent a disability and very unlikely to influence whether the child has a happy and fulfilled life or not.

Can I go right back to the gym after surgery?

No. I recommend that patients avoid training chest for four weeks. They should start that third week with light weights, maybe machines, even, just to get the blood flowing and so on. Gradually, heavier weights can be used. By not training chest for three or four weeks, they can avoid development of a fluid collection or other problem in the are of the surgery. After that, they should start back in slowly to avoid injury. Most patients are back to normal six weeks after their surgery, but their sanity has been maintained since they've been training all along.

What is Dupuytrens Contracture and can anything be done about it?

This is a genetically predisposed disease of unknown etiology, but is common in those countries that received the "Viking diaspora": ie Scandinavia, Britain, and then the British colonies. It is almost unheard of in native africans for instance.

The condition is simply a fibrous scar like affliction of the fascial layer of the palm. which is the layer that binds the skin of the palm or sole to the underlying skeleton. Without this layer the skin would skid about as it does on the back of the hand, preventing firm grasping. The first sign of the affliction is a nodule, usually in the palm in line with the ring or little finger. This may persist for mnay years without progressing. Conversely it may develop bands running from the lump to the finger and palpable beneath or even within the skin. These bands then contract slowly and draw the finger inexorably toward the palm. they may proliferate into other adjacent digits, or appear in the opposite hand, or foot. Very occasionaly they can afflict the penis.

There is no medical treatment, despite press hype to the contrary. Surgery is reserved for treatment of contractures and is NOT generally advisable for the isolated nodule, since the paradox of surgery is that it may hasten the development of the disease. Simple surgery is often effective, and further surgery may be necessary after some years if the disease progresses or appears elswhere. In sveere cases recurrence can be delayed or contained by careful use of skin grafts to eliminate involved skin areas in discrete zones of the hand.

There are associations with the disease, but no serious systemic manifestations, and there is no predisposition ot malignancy of any sort.

How long will it take before everything gets back to normal?

It may take you up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be less.

Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Most scars will fade substantially over time, though it may take as long as one to two years, However, they'll never disappear entirely. The better the quality of your overall reconstruction, the less distracting you'll find those scars.

Follow your surgeon's advice on when to begin stretching exercises and normal activities. As a general rule, you'll want to refrain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction

How many techniques are there for liposuction?

There is the Tumescent technique which is widely used by doctors every where. With the tumescent technique, if the surgeon does not over inject the area with TOO MUCH Lidocaine solution, this technique is proving best. Once upon a time they just shoved the hose in there and sucked away. With the tumescent technique, they engorge the tissues with a saline/Lidocaine solution and suction the fat cells which are not engorged with the solution. This technique also hinders of suctioning out of tissues that are not targeted for removal and lessens bleeding. However, if a surgeon injects too much of the solution the patient can get Lidocaine toxicity which can cause sickness, complications and sometimes death. Although Lidocaine toxicity is most often seen in body sculpture where large amounts of solution in injected within the body and the operation my require a longer period of anesthesia.

There is also a Super-wet technique which is basically like the Tumescent but with not as much solution injected. It breaks down to about the same amount injected as the amount of fat removed.

There is also the Ultra Sonic technique (UAL) which is regularly leaving patents with serious post-operative burns. Apparently the high frequency waves are over-exciting the water particles (or any fluid containing) causing them to boil beneath the skin as well as damaging superficial tissues as well.

And lastly there is the Power-Assisted Liposuction (PAL or MicroAire Technique). PAL is a newer technique where the cannula eases through the fatty tissue (even fibrous) with less trauma than traditional techniques and with no burn risks as with the UAL techniques. This new machine uses a special high-speed "linear reciprocating" suction cannula. You see, with the newer cannula surgeons are able to perform more effective high-volume liposuction in a shorter time, without trauma, especially in more fibrous areas. Fibrous tissue has always been a problem in the buttocks, saddlebags (upper sides of thighs in women), back and the male breast (gynecomastia). The PAL system moves through these areas faster, with less trauma resulting in less work and strain for the surgeon and less pain and a faster recovery in patients.

Is liposuction permanent?

To a certain degree, yes. Although the fat will return if you over eat and gain weight. The remaining fat cells have an extraordinary ability to expand considerably to compensate for any fat cells removed from liposuction. Liposuction, in any application, is not to be used for weigh loss. Patients have died from suctioning out too much of their body's fluids. Your body needs fat and fluid to function. You must realize, that if you gain weight you will re-gain the fat stores in your neck and face. Although it may not look the same or be as much. The fat cells will compensate and engorge themselves and sell. It is reported that fat cells are able to divide if they become too large.

What does a typical liposuction consultation entail?

First off, your doctor will discuss your goals with you and he will explain what can be achieved realistically. A surgeon should take into account what your body structure is and be able to recognize where your fat is needed. Which is pretty much everywhere -- just not in excess. There is no "one size fits all" technique when it comes to this procedure. It is all individual.

What happens after your breast reconstruction surgery?

You are likely to feel tired and sore for a week or two after reconstruction. Most of your discomfort can be controlled by medication prescribed by your doctor.

Depending on the extent of your surgery, you'll probably be released from the hospital in two to five days. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery. Most stitches are removed in a week to 10 days.

How is liposuction performed?

Small incisions are made and the excess fat is suctioned out through these small incisions. Sometimes a tumescent technique is used where a solution of saline (delivery and tumescent agent ), Lidocaine (pain reliever) and epinephrine (prohibits bleeding) are injected into the targeted area. This technique's purpose is to engorge the tissues with the solution for a firmer working area and the fat cells (which are softer) are suctioned out. The epinephrine prohibits bleeding during the operation and less blood is lost during the procedure.

There is a technique which involves ultrasonic waves. These ultrasonic waves excite the tissues water molecules (fat molecules being the target) and literally melt the fat into a liquid for ease of removal by suction. Unfortunately, each patient's molecules may react differently or in the case of unskilled surgeons, may improperly handle the equipment resulting in severe burns.

Either way, the targeted fat is suctioned out, sutures are sometimes used in the closure of incisions, a bit of surgical tape or Steri-Strips? are placed over the incision and a support garment is worn for proper, compact healing.

What is breast reconstruction?

Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.

But bear in mind, post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider as you and your doctor explore what's best for you.

This information will give you a basic understanding of the procedure — when it's appropriate, how it's done, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your surgeon if there is anything you don't understand about the procedure.

Where are the incisions made?

The incisions are made within the natural folds of the body which are usually near the pubic area, the inner knees several places along the thighs, etc. There are no folds there normally. Unnecessary scarring is generally avoided in all techniques. Discuss with your doctor his or incision placement of choice and why?

Who is a candidates for breast reconstruction surgery?

Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.

Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the options while they're struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking, may also be advised to wait.

In any case, being informed of your reconstruction options before surgery can help you prepare for a mastectomy with a more positive outlook for the future.

What should I expect post-operatively?

You may feel a little sore but excessive pain is very rare with liposuction. It's more of an uncomfortable soreness. Your pain relievers prescribed by your doctor should alleviate this pain. You will be asked to wear a support garment postoperatively for the first few days and then only at night for a few weeks if there was excessive removal of facial fat. This will insure proper healing in the surrounding tissues for a more compact appearance.

Is it quite painful? Is there much bruising?

It takes about a week and a half for most of the swelling to subside. There is really not too much bruising with average cases, although it should be looked upon as individual. Some are prone to bruising more than others. You should take your prescribed pain medication to alleviate any pain or discomfort that you may experience.

What are the risks?

Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure.

In general, the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they're relatively uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.

If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.

Reconstruction has no known effect on the recurrence of disease in the breast, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant.

Women who postpone reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think of the reconstructed breast as her own.

When will I be able to return to work?

Most patients return to work within 2 weeks. Although some patients have returned just after 5 days. It is highly individual. The swelling is more than likely the main reason people tend to take off work. The bruising, if any, can be camouflaged with cosmetics. Still, you should not bend over or exercise until well after 3 weeks post-op.

Planning your breast reconstruction surgery.

You can begin talking about reconstruction as soon as you're diagnosed with cancer. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.

After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence — but keep in mind that the desired result is improvement, not perfection.

Your surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. In most cases, health insurance policies will cover most or all of the cost of post-mastectomy reconstruction. Check your policy to make sure you're covered and to see if there are any limitations on what types of reconstruction are covered.

When will I be able to see the results?

After the swelling subsides you will begin to notice a difference in the compact appearance of your tissues. It is advised to take before and after photos to fully appreciate the results as a gradual decrease in swelling will give your mind time to accustom itself to the changes. They may not seem too great to you, but with photos your appreciation and understanding of the results are clarified through visual realization.

What are the risks of liposuction?

There are more risks with liposuction due to the fat and its surrounding tissues becoming necrotic (dead tissue). If the fat becomes necrotic from lack of blood supply, the fat tends to turn orange-ish clear and drain from the incision. If the tissue becomes necrotic, that's a completely different story. You must have the tissue removed before a major infection develops, possibly causing gangrene. Even with the ultrasonic technique, patients have been known to receive actual burns from the ultrasonic technique. The fat is actually melted within the body by 'exciting' the fat molecules with high frequency radio waves and is suctioned out. There may be asymmetry, hyper-pigmentation (permanent dark spots) from the bruising. Major blood loss is a factor is some cases. As is hematoma and infection. Liposuction is NOT the way to lose weight.

Another risk of liposuction* is pulmonary Thromboemboli. A thromboebolus is a blood clot and this blood clot can break free and travel to the lungs resulting in pulmonary Thromboemboli. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma - leading to the patient becoming 'brain dead' shortly thereafter or in a vegetative state from loss of oxygen to the brain. Pulmonary Thromboemboli can happen within three weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. However, pulmonary Thromboemboli can occur suddenly, without warning. Most patients with P.E. collapse and begin rapid deterioration after attempting to climb a flight of stairs.

*facial liposuction risks are far less than body liposuction due to the amount of fat that is suctioned and disrupted.

How should I prepare for your breast reconstruction surgery?

Your oncologist and your plastic surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Where will my breast reconstruction surgery be performed?

Breast reconstruction usually involves more than one operation. The first stage, whether done at the same time as the mastectomy or later on, is usually performed in a hospital.

Follow-up procedures may also be done in the hospital. Or, depending on the extent of surgery required, your surgeon may prefer an outpatient facility.

What is otoplasty?

Otoplasty is the repair of abnormalities of the external portion of the ear and is a very commonly requested operation. The results are very satisfying to the patient and family and often the outlook of the patient will change dramatically after the operation. This is particularly true with children. When ears protrude notably or are abnormal in some way, children are often teased by their peers. They are general self-conscious and in some instances are shy and introverted solely due to the constant teasing of their friends. Adults will often wear their hair in ways that will hide the ears. Many mothers have recounted how the personality of their child has blossomed after otoplasty. Some have noted an improvement in school grades.

Types of anesthesia for breast reconstruction surgery.

The first stage of reconstruction, creation of the breast mound, is almost always performed using general anesthesia, so you'll sleep through the entire operation.

Follow-up procedures may require only a local anesthesia, combined with a sedative to make you drowsy. You'll be awake but relaxed, and may feel some discomfort.

How is otoplasty performed?

Except in children, the operation is performed using light sleep anesthesia. In children less than 8 years, the operation is always performed under general anesthesia. All incisions are placed behind the ear so there are no visible scars after the operation. If the ears are protruding they may be rotated back. If some of the natural folds are missing they are created. Missing or abnormal sections of the ear may be constructed from tissues taken from other parts of the ear or from other areas of the body. Ears that have been injured, most commonly in wrestling, and are thickened can be thinned and sculpted. At the end of the operation a pressure dressing is worn.

The operation is mostly performed in children around age 6. The child generally follows instructions well because he/she is so happy to have the problem repaired and pleased with the results.

Where are the incisions made?

The incisions will generally be made in the most inconspicuous places such as behind the ear or within the natural folds and curvatures of the ear structure. Discuss with your doctor the incisions he plans on making for your desired results. Some removal of cartilage may be necessary.

What types of breast implants are there?

If your surgeon recommends the use of an implant, you'll want to discuss what type of implant should be used. A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline.

Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast implants, the Food & Drug Administration (FDA) has determined that new gel-filled implants should be available only to women participating in approved studies. This currently includes women who already have tissue expanders, who choose immediate reconstruction after mastectomy, or who already have a gel-filled implant and need it replaced for medical reasons. Eventually, all patients with appropriate medical indications may have similar access to silicone gel-filled implants.

What should I expect post-operatively?

The pressure dressing is removed after 5-7 days. Children should be kept relatively quiet during that time. The dressing should not get wet. After removal of the dressing, a sweat band should be worn, at night only, to protect the ears until the end of the sixth post-operative week. Normal non-strenuous activity may be resumed two days after surgery. The patient should refrain from bending over for 3 weeks, keeping the head higher than the heart during that time. Nor should the patient sleep on his side for 3 weeks. Routine exercise may begin at the end of the fourth post-operative week. Contact sports may be restarted at the end of the sixth post-operative week.

Is it quite painful? Is there much bruising?

It takes about a week and a half for most of the swelling to subside, although it will be sensitive to light to medium pressure for about 3 weeks. There is really not much bruising with average cases, although it should be looked upon as individual. Some are prone to bruising more than others. Some doctors prescribe a pharmaceutical grade Arnica montana product called SinEcch and a topical ointment as well. These two products are thought to decrease both bruising and swelling in all procedures and in most cases have shown a significant decrease in both complaints. There is normally very little pain involved post-operatively. Also look into Bromelain.

What happens during breast reconstruction surgery?

While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that's best for you.

Skin expansion. The most common technique combines skin expansion and subsequent insertion of an implant.

Flap reconstruction. An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.

Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. But keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.

Your new look after breast reconstruction surgery

Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.

When will I be able to see the results?s

You shouldn't even peek at it for 5 to 7 days until the pressure dressing is removed. If you do, it could increase infection or the results may be altered by your tampering. Abide by your doctor's instructions and do not attempt to remove the bandages unless he/she specifically instructs it. After your dressings are removed you will see an immediate difference in the protuberance of the ear. Even though there will be some residual swelling, the results are generally very satisfying to the patient.

What are the risks of otoplasty?

The risks of the operation are bleeding and infection. Both are exceedingly rare. With proper post-operative care this is a very safe and satisfying operation that carries very little risk, beautiful results, and almost no discomfort from the operation itself.

The patient should note that the ears can often feel numb for 2 to 3 months after the operation. The sensation returns slowly over that time. This is the reason that there is generally no pain in the post-operative period. This fact makes the operation exceptionally well tolerated in children.

What is Arnica montana, I have heard that it reduces swelling and bruising? Which is the best kind to take?

Also known as: Mountain Tobacco, Mountain Arnica, Common Arnica, Leopard's Bane and Sneezewort

Plant family: Asteraceae

Type: Herbaceous perennial

Parts used: Roots and flowers

Description: Arnica montana or Leopard's Bane is a perennial herb, growing close to the ground. The leaves form a flat rosette, from the center of which rises a flower stalk, 1 to 2 feet high, bearing orange-yellow flowers. The rhizome is dark brown, cylindrical, usually curved, and bears brittle wiry rootlets on the under surface.

Habitat: Indigenous to Central Europe, in woods and mountain pastures, although it has been found in England and Southern Scotland.

Warning: This herb should NEVER be taken in raw form. This plant, like many medicinal plants if ingested, can cause intestinal bleeding, abdominal cramping and sickness. Homeopathy is the medicinal use of tinctures and suspensions using herbs and other plants and should never be consumed without proper preparation. Only respectable homeopathic remedies and tinctures should be consumed.
ALWAYS ASK YOUR SURGEON FIRST BEFORE TAKING ANY MEDICATION.

What is rhinoplasty?

Rhinoplasty is cosmetic surgery of the nose. It is also known as nasal refinement and the layman's term nose job. With rhinoplasty, 'defects' from either birth or trauma can be corrected by infracturing or breaking the bones of the nose and re-setting them in the desired shape, often narrow and straight.

A hump may be removed to give a more pleasing, symmetrical look. The cartilages of the nose can be molded and trimmed to create a more compact or pleasing shape. Rhinoplasty can soften an otherwise beautiful face by refining one's features.

When can rhinoplasty be performed?

Extensive nasal surgery is generally avoided in children. There are major growth centers in the nose that affect the growth of the face. In cases of severe disfigurement due to accidents, surgery is performed in an attempt to restore the alignment of those centers. For lesser deformities surgery is deferred until after the child stops growing. Rhinoplasties performed on teenagers and young adults, it seems, are often beneficial to the social development and self confidence of the individual. The aging process is reflected in many ways in the nose and its correction can add youthfulness and freshness to the appearance.

What is rhinoplasty?

Rhinoplasty is cosmetic surgery of the nose. It is also known as nasal refinement and the layman's term nose job. With rhinoplasty, 'defects' from either birth or trauma can be corrected by infracturing or breaking the bones of the nose and re-setting them in the desired shape, often narrow and straight.

A hump may be removed to give a more pleasing, symmetrical look. The cartilages of the nose can be molded and trimmed to create a more compact or pleasing shape. Rhinoplasty can soften an otherwise beautiful face by refining one's features.

What does a typical Rhinoplasty consultation entail?

First, your doctor will discuss your goals with you and he will explain what can be achieved realistically. A good doctor will not just slim your nose or shorten it, rather he will take into account what your facial features and bone structure would benefit from. Be it a slimmer more defined or perhaps more turned up. Perhaps it is only a hump that is desired to be removed, making it unnecessary to even have a Full Rhinoplasty. There is no "one size fits all" when it comes to this procedure. It is all individual. Just like you!

When can rhinoplasty be performed?

Extensive nasal surgery is generally avoided in children. There are major growth centers in the nose that affect the growth of the face. In cases of severe disfigurement due to accidents, surgery is performed in an attempt to restore the alignment of those centers. For lesser deformities surgery is deferred until after the child stops growing. Rhinoplasties performed on teenagers and young adults, it seems, are often beneficial to the social development and self confidence of the individual. The aging process is reflected in many ways in the nose and its correction can add youthfulness and freshness to the appearance.

What should I expect post-operatively?

After your surgery your surgeon will have placed a pressure dressing over your eyes and a gauze pad underneath your nose to catch blood and mucous. You will remove the pressure dressing after a few hours or as specified by your surgeon. You may become sick from ingested blood during the procedure and vomit, expelling a black mixture of stomach acid and blood. This will pass as soon as the blood is expelled. It really isn't that much so you shouldn't be sick for long unless you were under general anesthesia -- you may become sick from this alone. Your doctor can give you special medications to remedy or prevent this. If you continue to vomit and/or run a high fever, contact your doctor immediately.

You nose will be sensitive for approximately a month and a half although patients report no serious pain or discomfort. However, patients do report the discomfort of breathing with the packing and cast on the nose. Some patients feel claustrophobic feeling as if they cannot breathe. This feeling widely resembles a head cold or sinus infection. Only when the cast is removed do you feel slight discomfort, unless you bump it accidentally.

What does a typical Rhinoplasty consultation entail?

First, your doctor will discuss your goals with you and he will explain what can be achieved realistically. A good doctor will not just slim your nose or shorten it, rather he will take into account what your facial features and bone structure would benefit from. Be it a slimmer more defined or perhaps more turned up. Perhaps it is only a hump that is desired to be removed, making it unnecessary to even have a Full Rhinoplasty. There is no "one size fits all" when it comes to this procedure. It is all individual. Just like you!

How is rhinoplasty performed?

Usually, Light Sleep Anesthesia is utilized. A Rhinoplasty can also be performed under General Anesthesia. The patient usually arrives early and medications are administered and supplemented with intravenous medication. After you are asleep and your vital signs are determined as safe and stable, local anesthesia is then applied to the nose. Surgery generally lasts about one and a half hours. The patient experiences no pain during the surgery.

A splint or cast is applied and will be worn for approximately 7 days. Many patients remember very little about the surgery. After the procedure is completed, the patient then recovers in a relaxed environment and monitored for a couple of hours before being driven home by a companion. You absolutely can not drive yourself home after a ANY procedure.

When will the cast be taken off and does this hurt?

The cast is removed approximately 7 days post-operatively. You may feel a slight stiffness in the upper lift as the swelling moves downward. This will subside in a matter of hours. you must be very careful not to bump it as it is vulnerable to breakage. It isn't a bone china figurine but it isn't as strong as your nose was before the rhinoplasty either. Don't worry, the bones will completely mend within 2 months.

If you had a rhinoplasty where the nostrils were narrowed (in the case of flared nostrils) you will have your sutures removed. This may sting a bit, especially since it is in a sensitive area. Although most patients still feel numb in the tip area and report only minor discomfort.

What should I expect post-operatively?

After your surgery your surgeon will have placed a pressure dressing over your eyes and a gauze pad underneath your nose to catch blood and mucous. You will remove the pressure dressing after a few hours or as specified by your surgeon. You may become sick from ingested blood during the procedure and vomit, expelling a black mixture of stomach acid and blood. This will pass as soon as the blood is expelled. It really isn't that much so you shouldn't be sick for long unless you were under general anesthesia -- you may become sick from this alone. Your doctor can give you special medications to remedy or prevent this. If you continue to vomit and/or run a high fever, contact your doctor immediately.

You nose will be sensitive for approximately a month and a half although patients report no serious pain or discomfort. However, patients do report the discomfort of breathing with the packing and cast on the nose. Some patients feel claustrophobic feeling as if they cannot breathe. This feeling widely resembles a head cold or sinus infection. Only when the cast is removed do you feel slight discomfort, unless you bump it accidentally.

When will I be able to see the results?

The nose will be very sensitive for approximately a month and a half. The patient will start to see a difference immediately but it will still be swollen. The swelling starts to generally disappear about a week after the cast is removed. Approximately 80% of the swelling and 100% of the discoloration are usually gone by 2 weeks after surgery. 90% of the swelling is gone by two months after surgery and the rest slowly disappears over the next year. Although the nose is still swollen after the first month, most people would not recognize this fact. The patient will not notice this swelling. Instead the patient will notice that the nose becomes more refined with better definition over the first year. The inside of the nose may be swollen for approximately three weeks after the surgery. Nasal breathing may be difficult during this time. If surgery is performed to straighten the nasal septum, an improvement in breathing will be appreciated at about 3 weeks.

What should I expect post-operatively?

After your surgery your surgeon will have placed a pressure dressing over your eyes and a gauze pad underneath your nose to catch blood and mucous. You will remove the pressure dressing after a few hours or as specified by your surgeon. You may become sick from ingested blood during the procedure and vomit, expelling a black mixture of stomach acid and blood. This will pass as soon as the blood is expelled. It really isn't that much so you shouldn't be sick for long unless you were under general anesthesia -- you may become sick from this alone. Your doctor can give you special medications to remedy or prevent this. If you continue to vomit and/or run a high fever, contact your doctor immediately.

You nose will be sensitive for approximately a month and a half although patients report no serious pain or discomfort. However, patients do report the discomfort of breathing with the packing and cast on the nose. Some patients feel claustrophobic feeling as if they cannot breathe. This feeling widely resembles a head cold or sinus infection. Only when the cast is removed do you feel slight discomfort, unless you bump it accidentally.

What are the risks of Rhinoplasty?

It is possible to develop tiny red marks and spots, this can be the result of blood vessels that may have burst under the skin's surface during the surgery. Although this is extremely infrequent it can happen and the spots may not ever go away. Scarring is minimal if the incisions are made inside of the nose, however when an "open" technique is used, or if narrowing of the nostrils is desired the scars made on the outside of the nose may be visible for am undetermined amount of time (usually until maturation). Even when a highly skilled surgeon performs your surgery, sometimes your body may not heal correctly or have adverse reactions causing undesired results. If so it is quite possible that additional surgeries may be needed. Some patients will lose their sense of smell, temporarily. Your nose may be slightly swollen and for over a year. Scar tissue may heal in a way that may cause a whistling sound to be heard when you breathe in and out.

This surgery has the highest rate of revisions. It seems that some people, especially mature people, may not readily accept the new look. Being accustomed to their old nose, they just can't seem to comfortably make the transition. Although there are a few rhinoplasties that just don't heal correctly, due to something as serious as human error (the surgeon's) or as simple as not having your head elevated enough or sleeping on one side a lot without a proper cast. The nose can pull to one side if the cast does not support it properly in the first week. Or quite simply, your body may just heal that way.

When will the cast be taken off and does this hurt?

The cast is removed approximately 7 days post-operatively. You may feel a slight stiffness in the upper lift as the swelling moves downward. This will subside in a matter of hours. you must be very careful not to bump it as it is vulnerable to breakage. It isn't a bone china figurine but it isn't as strong as your nose was before the rhinoplasty either. Don't worry, the bones will completely mend within 2 months.

If you had a rhinoplasty where the nostrils were narrowed (in the case of flared nostrils) you will have your sutures removed. This may sting a bit, especially since it is in a sensitive area. Although most patients still feel numb in the tip area and report only minor discomfort.

Are there any new techniques to repair a deviated septum. Is cauterization used? Does the nose always have to be packed after surgery?

There are many ways to fix a septum. Generally cautery is used only on the turbinates or the initial incision on the columella in open techniques. The septum is like a wall frame in a house. The skin (mucosa) over it is like wall paper, and the cartilage on the inside is like drywall. You place an incision in the front part of the nose where it is hidden and raise the wallpaper off the wall. Then you can perform the necessary correction to the drywall (cartilage) and when you put the "wall paper" (mucosa/skin) back it looks like nothing was done.

Usually packing will be required however, some patients are eligible for tubes or straws placed in the center of the packing on each side so that direct airflow through the nose is possible. Most patients find this a psychological discomfort rather than a physical.

When will I be able to see the results?

The nose will be very sensitive for approximately a month and a half. The patient will start to see a difference immediately but it will still be swollen. The swelling starts to generally disappear about a week after the cast is removed. Approximately 80% of the swelling and 100% of the discoloration are usually gone by 2 weeks after surgery. 90% of the swelling is gone by two months after surgery and the rest slowly disappears over the next year. Although the nose is still swollen after the first month, most people would not recognize this fact. The patient will not notice this swelling. Instead the patient will notice that the nose becomes more refined with better definition over the first year. The inside of the nose may be swollen for approximately three weeks after the surgery. Nasal breathing may be difficult during this time. If surgery is performed to straighten the nasal septum, an improvement in breathing will be appreciated at about 3 weeks.

I am 16 and have been thinking of rhinoplasty for a long time. At what age is it safe to have a rhinoplasty?

Usually rhinoplasty is performed at the earliest, 13 or 14 years of age in girls and 15 to 16 years of age in boys. Reason being, and it is a known fact, girls physically mature faster than boys and the collective goal is to perform surgery when at least 90% of the growth is complete. There are major growth centers in the nose that affect the growth of the face.

In cases of severe disfigurement due to accidents, surgery is performed in an attempt to restore the alignment of those centers. For lesser deformities surgery is deferred until after the teen stops growing. Rhinoplasties performed on teenagers and young adults, it seems, are often beneficial to the social development and self confidence of the individual.

In other words, this depends upon the stage of growth in the face as well as the gender of the patient. A qualified surgeon can better help you upon personal examination.

What are the risks of Rhinoplasty?

It is possible to develop tiny red marks and spots, this can be the result of blood vessels that may have burst under the skin's surface during the surgery. Although this is extremely infrequent it can happen and the spots may not ever go away. Scarring is minimal if the incisions are made inside of the nose, however when an "open" technique is used, or if narrowing of the nostrils is desired the scars made on the outside of the nose may be visible for am undetermined amount of time (usually until maturation). Even when a highly skilled surgeon performs your surgery, sometimes your body may not heal correctly or have adverse reactions causing undesired results. If so it is quite possible that additional surgeries may be needed. Some patients will lose their sense of smell, temporarily. Your nose may be slightly swollen and for over a year. Scar tissue may heal in a way that may cause a whistling sound to be heard when you breathe in and out.

This surgery has the highest rate of revisions. It seems that some people, especially mature people, may not readily accept the new look. Being accustomed to their old nose, they just can't seem to comfortably make the transition. Although there are a few rhinoplasties that just don't heal correctly, due to something as serious as human error (the surgeon's) or as simple as not having your head elevated enough or sleeping on one side a lot without a proper cast. The nose can pull to one side if the cast does not support it properly in the first week. Or quite simply, your body may just heal that way.

I'm getting a deviated septum and a hump fixed all in one and I wanted to know what kind of scarring I should expect. Also, how long is it after the operation that I'll see good results?

Usually, there is no visible scarring unless it is an open rhinoplasty. Some surgeons perform all of their rhinoplasties, open -- some, all closed. It solely depends upon the surgeon. You will find that most surgeons tend to disagree when it comes to technique. They either prefer open or they prefer closed, OR if they are highly skilled, know that it is case-dependent and different patients have different needs. If it is an open rhinoplasty the scar would be on the columella (the skin that separates the nostrils) sometimes resembling a straight line or a flattened z.

You can expect swelling, especially in the tip if you are having tip work performed. The swelling usually begins to subside within the first month but the end result may not be seen until at least 9 months [post-operatively. Although this time period tends to lean towards a year and over.

Are there any new techniques to repair a deviated septum. Is cauterization used? Does the nose always have to be packed after surgery?

There are many ways to fix a septum. Generally cautery is used only on the turbinates or the initial incision on the columella in open techniques. The septum is like a wall frame in a house. The skin (mucosa) over it is like wall paper, and the cartilage on the inside is like drywall. You place an incision in the front part of the nose where it is hidden and raise the wallpaper off the wall. Then you can perform the necessary correction to the drywall (cartilage) and when you put the "wall paper" (mucosa/skin) back it looks like nothing was done.

Usually packing will be required however, some patients are eligible for tubes or straws placed in the center of the packing on each side so that direct airflow through the nose is possible. Most patients find this a psychological discomfort rather than a physical.

How much would a rhinoplasty, without insurance ect...be? Is the average price range like $5000 to $6000?

It really depends upon your region and the amount of work performed. If you just need a Tiplasty, with no bone work then it can average about $3,800.US. and up. The averages are as follows:

I am 16 and have been thinking of rhinoplasty for a long time. At what age is it safe to have a rhinoplasty?

Usually rhinoplasty is performed at the earliest, 13 or 14 years of age in girls and 15 to 16 years of age in boys. Reason being, and it is a known fact, girls physically mature faster than boys and the collective goal is to perform surgery when at least 90% of the growth is complete. There are major growth centers in the nose that affect the growth of the face.

In cases of severe disfigurement due to accidents, surgery is performed in an attempt to restore the alignment of those centers. For lesser deformities surgery is deferred until after the teen stops growing. Rhinoplasties performed on teenagers and young adults, it seems, are often beneficial to the social development and self confidence of the individual.

In other words, this depends upon the stage of growth in the face as well as the gender of the patient. A qualified surgeon can better help you upon personal examination.

I'm getting a deviated septum and a hump fixed all in one and I wanted to know what kind of scarring I should expect. Also, how long is it after the operation that I'll see good results?

Usually, there is no visible scarring unless it is an open rhinoplasty. Some surgeons perform all of their rhinoplasties, open -- some, all closed. It solely depends upon the surgeon. You will find that most surgeons tend to disagree when it comes to technique. They either prefer open or they prefer closed, OR if they are highly skilled, know that it is case-dependent and different patients have different needs. If it is an open rhinoplasty the scar would be on the columella (the skin that separates the nostrils) sometimes resembling a straight line or a flattened z.

You can expect swelling, especially in the tip if you are having tip work performed. The swelling usually begins to subside within the first month but the end result may not be seen until at least 9 months [post-operatively. Although this time period tends to lean towards a year and over.

How much would a rhinoplasty, without insurance ect...be? Is the average price range like $5000 to $6000?

It really depends upon your region and the amount of work performed. If you just need a Tiplasty, with no bone work then it can average about $3,800.US. and up. The averages are as follows:

It's been five months since my surgery and now since I started to get back in shape and returned to my gym. I have notice that when I run and workout my nose drips. It is very runny, here I am walking away and every few min. I have to use a tissue. Is thi

Many patients complain of runny noses after rhinoplasty/septoplasty surgery. Some over 2 years. Most of the excess mucous production ceases at 9 months but can continue well after that. For now I can only advise to carry more Kleenex around as it may persist for several more months.

My PS mentioned a shot of cortisone to help some of the scar tissue. Why is this and what will this do?

A Injections of Cortisone or Kenalog can help break up excess tissue. It is a common remedy to inject steroids such as these and also is used primarily to reduce swelling and inflamed tissue. Although care must be taken regarding excess use of these injections as it can break down the tissue too much.

Is this just part of the healing stage or need I bring this up to my doctor? Its really annoying! Has anyone experienced this at all?

It's been five months since my surgery and now since I started to get back in shape and returned to my gym. I have notice that when I run and workout my nose drips. It is very runny, here I am walking away and every few min. I have to use a tissue. Is this just part of the healing stage or need I bring this up to my doctor? Its really annoying! Has anyone experienced this at all?

Many patients complain of runny noses after rhinoplasty/septoplasty surgery. Some over 2 years. Most of the excess mucous production ceases at 9 months but can continue well after that. For now I can only advise to carry more Kleenex around as it may persist for several more months.

My PS mentioned a shot of cortisone to help some of the scar tissue. Why is this and what will this do?

A Injections of Cortisone or Kenalog can help break up excess tissue. It is a common remedy to inject steroids such as these and also is used primarily to reduce swelling and inflamed tissue. Although care must be taken regarding excess use of these injections as it can break down the tissue too much.

My PS mentioned a shot of cortisone to help some of the scar tissue. Why is this and what will this do?

A Injections of Cortisone or Kenalog can help break up excess tissue. It is a common remedy to inject steroids such as these and also is used primarily to reduce swelling and inflamed tissue. Although care must be taken regarding excess use of these injections as it can break down the tissue too much.

My PS mentioned a shot of cortisone to help some of the scar tissue. Why is this and what will this do?

A Injections of Cortisone or Kenalog can help break up excess tissue. It is a common remedy to inject steroids such as these and also is used primarily to reduce swelling and inflamed tissue. Although care must be taken regarding excess use of these injections as it can break down the tissue too much.

I'm going to get my nose done soon and my doctor also recommended me getting a chin implant because he says my nose will still appear 'big' since my chin goes a little further in then it should...Do people get both these procedures at the same time? And d

This is very common. A weak chin can and does make even an ideal sized nose look larger than it actually is. The chin augmentation is a relatively minor procedure when implants are used although it entails some risks all on its own. Such as lower lip numbness which can be remedied (usually) by removing the implant and trimming the implant so that it is not pressing up against the nerve as much.

I have to get my cast off soon and wanted to know if it is going to hurt? Is there anything I can do beforehand?

Most patients report a little tenderness when the cast is removed but if your surgeon uses a cotton swab saturated with alcohol to help remove the adhesive from the tape and glue you should be okay. Although it really shouldn't cause you great discomfort.

The sutures that may be removed may hurt when someone else removes it due to them not actually being able to tell when they are hurting you. They also may snip your flesh slightly when the scissors are used to cut the actual suture. This isn't as rare as it as it should be and solely depends upon the surgeon's meticulous nature.

Do people get both these procedures at the same time? And do you recommend I should do this?

I'm going to get my nose done soon and my doctor also recommended me getting a chin implant because he says my nose will still appear 'big' since my chin goes a little further in then it should...Do people get both these procedures at the same time? And do you recommend I should do this?

This is very common. A weak chin can and does make even an ideal sized nose look larger than it actually is. The chin augmentation is a relatively minor procedure when implants are used although it entails some risks all on its own. Such as lower lip numbness which can be remedied (usually) by removing the implant and trimming the implant so that it is not pressing up against the nerve as much.

I have to get my cast off soon and wanted to know if it is going to hurt? Is there anything I can do beforehand?

Most patients report a little tenderness when the cast is removed but if your surgeon uses a cotton swab saturated with alcohol to help remove the adhesive from the tape and glue you should be okay. Although it really shouldn't cause you great discomfort.

The sutures that may be removed may hurt when someone else removes it due to them not actually being able to tell when they are hurting you. They also may snip your flesh slightly when the scissors are used to cut the actual suture. This isn't as rare as it as it should be and solely depends upon the surgeon's meticulous nature.

I have thick nasal skin and a surgeon I spoke with said that I may not be able to see much detail with my rhinoplasty? Is this true? Should I see another surgeon?

For many patients with thick skin, the skin is thinned out in the surgery as the tip is worked on. This really adds a lot to help with definition . Excess skin length just shrinks away as the swelling decreases. Also, many patients with thick skin actually do better with rhinoplasties because the flaps that are elevated are so firm that you can do a lot more with the cartilages and it is better hidden. Very thin skin, shows every little imperfection.

Going on several consults and getting a second, third and even more opinions is a good idea in any case. Searching for surgeons is a serious matter and you should be as comfortable as you can be with a surgeon, his skill, and his bedside manner.

I have thick nasal skin and a surgeon I spoke with said that I may not be able to see much detail with my rhinoplasty? Is this true? Should I see another surgeon?

For many patients with thick skin, the skin is thinned out in the surgery as the tip is worked on. This really adds a lot to help with definition . Excess skin length just shrinks away as the swelling decreases. Also, many patients with thick skin actually do better with rhinoplasties because the flaps that are elevated are so firm that you can do a lot more with the cartilages and it is better hidden. Very thin skin, shows every little imperfection.

Going on several consults and getting a second, third and even more opinions is a good idea in any case. Searching for surgeons is a serious matter and you should be as comfortable as you can be with a surgeon, his skill, and his bedside manner.

Is it improper to ask to speak with previous patients who have had revision rhinoplasty done by the surgeon I am considering for the same procedure?

Not at all! And you absolutely should. All surgeons should have a referral list of prior patients to discuss particulars and trade stories. I personally spoke with patients beforehand and as a matter of fact am on my own doctor's referral list.

If you are wondering if all of the patients are going to be happy or receive compensation... I have found in my experience that there are about 1 to 2 patients who wish they had done more research beforehand or had gone to another doctor entirely so be advised that although this is unfortunate I think it is helpful to the patient considering the procedure to gain a well-rounded opinion.

Is it improper to ask to speak with previous patients who have had revision rhinoplasty done by the surgeon I am considering for the same procedure?

Not at all! And you absolutely should. All surgeons should have a referral list of prior patients to discuss particulars and trade stories. I personally spoke with patients beforehand and as a matter of fact am on my own doctor's referral list.

If you are wondering if all of the patients are going to be happy or receive compensation... I have found in my experience that there are about 1 to 2 patients who wish they had done more research beforehand or had gone to another doctor entirely so be advised that although this is unfortunate I think it is helpful to the patient considering the procedure to gain a well-rounded opinion.

What is a "hanging columella"?

A nasal columella is the external, and sometimes partial internal, fleshy section of the nose which separates the nostrils. When it is referred to being a hanging columella this section is often prominent or hangs down.

What is a "hanging columella"?

A nasal columella is the external, and sometimes partial internal, fleshy section of the nose which separates the nostrils. When it is referred to being a hanging columella this section is often prominent or hangs down.

Is it possible for someone to be allergic to dissolvable stitches? And if so, what would the reaction be?

This isn't as uncommon as you may think. There are usually two types that promote a response in those who are sensitive to these sutures. These two are usually Absorbable Poly(glycolide/L-lactide) Surgical Suture material and Absorbable Gut Suture material.

If you experience redness and itchiness and sometimes pus formation -- you very well may be allergic to the dissolvable type sutures. Sometimes the symptoms may not show up until about 3 to 4 weeks after surgery, if this happens, antibiotics can be given but it usually reoccurs. The best thing to do in some cases is to remove any of the left over material and replace it with nylon sutures. These sutures are usually removed in 10 days. Another option can be tissue glue although this isn't very mainstream for rhinoplasty.

Also be advised that when the skin gets red and itchy around a suture, be it absorbable or non-dissolving -- usually it is time for them to be removed. Your body knows and will tell you when your healing. Besides healing skin always turns itchy. Know the difference between typical irritation and an allergic reaction.

I used to be addicted to cocaine. As a result, my past (I'm recovered) addiction left a hole inside my nose, between my nostrils. Can I have the hole filled?

Most of the holes that come from cocaine are large and not treatable. A silicone button can in some cases be placed to close the hole.

Is it possible for someone to be allergic to dissolvable stitches? And if so, what would the reaction be?

This isn't as uncommon as you may think. There are usually two types that promote a response in those who are sensitive to these sutures. These two are usually Absorbable Poly(glycolide/L-lactide) Surgical Suture material and Absorbable Gut Suture material.

If you experience redness and itchiness and sometimes pus formation -- you very well may be allergic to the dissolvable type sutures. Sometimes the symptoms may not show up until about 3 to 4 weeks after surgery, if this happens, antibiotics can be given but it usually reoccurs. The best thing to do in some cases is to remove any of the left over material and replace it with nylon sutures. These sutures are usually removed in 10 days. Another option can be tissue glue although this isn't very mainstream for rhinoplasty.

Also be advised that when the skin gets red and itchy around a suture, be it absorbable or non-dissolving -- usually it is time for them to be removed. Your body knows and will tell you when your healing. Besides healing skin always turns itchy. Know the difference between typical irritation and an allergic reaction.

I recently had a rhinoplasty & septoplasty, its almost 6 months & on one of my nostrils I still can hardly breath. Is this normal?

Usually by the 6th month the breathing is most definitely restored. In fact, most patients notice improved breathing within a month to two months of surgery if they had difficulty breathing beforehand. I would suggest that you have a follow up with your surgeon and ask his advice or determine if the lack of airway is indeed from a deviated septum, redundant mucosa or enlarged or redundant turbinates. I do not know from your question if this is a constant occurrence or if this is at certain times of the day, while the body is horizontal or after exercise. These factors can also hinder breathing due to engorged tissue due to increased blood flow.

How much does rhinoplasty cost?

Between $3,500 and $20,000US depending upon the level of correction needed, whether it is a primary or revision surgery, if there are grafts needed, be they autologous (from your own body) or synthetic, how many surgeries are needed for complete correction, functional needs (septoplasty, turbinectomy, sinus problems, polyp removal, etc.), anesthesia choice, region and surgeon.

What is plastic surgery?

Plastic surgery is a surgical specialty that reconstructs facial and body defects due to birth disorders, trauma, burns, and disease. The plastic surgery is also involved with the enhancement of the appearance of a person through such operations as rhinoplasty, breast augmentation, facelift and liposuction.

Plastic Surgery - Why the "Plastic"?

Will I be able to cope with the pain after the procedure?

Each patient tolerates pain post-operatively in a different way. Some patients experience pain as an ache, others have greater discomfort. Pain medications are prescribed for post-operative patients, and these aid to minimize the discomfort.

Most facial cosmetic operations have minimal postoperative discomfort. Liposuction is slightly more uncomfortable, and operations that require elevation or tightening of the muscles, such as breast augmentation or abdominoplasty have discomfort equal to that experienced after a cesarean section.

What causes the splotches of skin pigmentation that are commonly known as birthmarks? Why do they persist on one area of the skin?

Birthmarks fall into two major categories: vascular lesions, which are spongy and consist of blood vessels, and non-vascular pigmented lesions.

Vascular lesions are caused by abnormal development of blood vessels in the skin. Although they are usually present at birth, they may also develop later in life. They may also appear suddenly, persist for a while, and then disappear again. This can happen when the body is going through a big physiological change, such as puberty or pregnancy.

As with pigmented birthmarks, there are various different ways in which vascular malformations are presented. The two most common forms are port wine stains and venous plexi intricate networks of veins. Port wine stains are pinkish-red and flat, and may darken in colour to a purple colour several years after birth. They are usually found on the face, but may occur anywhere on the body, and they persist for life, although they can be treated by surgery or laser therapy. They may even grow larger and more conspicuous later in life, darkening, thickening or forming vascular bumps. Those that occur on the face may be associated with eye or brain problems. Venous plexi are thin and light blue, and may be flat or raised.

Haemangiomas are a third type of vascular lesion. They may develop after birth and consist of many tiny blood vessels bunched together. Haemangiomas occur in up to 2 per cent of newborns, but as many as 12 per cent of babies develop them by age one. Interestingly, they are more common in girls. Haemangiomas may change in size, and most disappear completely by age 10.

What is a port wine stain?

A port wine stain (naevus flammeus) is a red or purple birthmark which affects about 3 out of every 1000 babies. It is a type of blood vessel birthmark which presents at birth as a uniform flat red, purple or pink mark on the skin, often on one side of the body, usually the face. They are congenital overgrowths of small blood vessels in the skin. Port wine stains are twice as common in girls as boys, and they may darken with age, thicken with raised bumps (papules) or ridges and increase in size proportionally to the child's growth. They grow with the individual and do not improve over time. They can occur on any part of the skin surface but cause most concern when they affect the face.

What are the causes of port wine stains?

Port wine stains are caused by an abnormal development of blood vessels in the area of the skin where they are present. They are not inherited and are not related to anything that the parents may have done during pregnancy.

How do I remove my unwanted tattoo?

In order to remove a tattoo without a scar, a Q-Switched laser must be used. The term Q-Switched indicates that the laser is pulsed so quickly (billionths of a second) that it is able to dissolve the ink without destroying the live tissue in the process. Similar to running your hand over a candle very quickly, there's not enough time to burn the skin. There are only three types of Q-Switched lasers used for tattoo removal: Q-Switched Ruby (red light), Q-Switched Yag (infrared & green light) and Q-Switched Alexandrite (purple/red light). The reason for the three types of lasers is because they respond differently to different colors of ink.

How does the laser work?

The lasers deliver very short pulses of high intensity light into the treated area. The tattoo inks and pigments then selectively absorb the light without destroying the normal surrounding skin tissue in the process. The tattoo is dissolved into smaller ink particles that are harmlessly removed by the body's immune system in the weeks following treatment.

How many treatments will it require?

Removing a professionally applied tattoo is usually a fading process that requires a series of treatments spaced approximately 5-6 weeks apart. Professional tattoos usually require 5-10 treatments for complete clearing. The black-colored inks usually respond quicker then the bright-colored inks because they absorb the light better. The depth, color and amount of ink, as well as the location of the tattoo on your body are all determining factors in how long and how quick we will be able to remove your tattoo. Most amateur or otherwise known as "street tattoos" are removed in only 2-5 treatments scheduled about 4-5 weeks apart.

Does this process cause scarring?

Very rarely have any scars been seen while utilizing this process. Providing state of the art technology helps ensure patients that the risk of scarring is dramatically reduced. There have been occasions where some lighter or darker colored pigment persists from the tattoo site, but normally after the course of treatments is complete, the treated area is usually indistinguishable from normal surrounding skin.

Will my tattoo be removed completely?

Yes, in most cases tattoos can be completely removed. Though there are many factors involved in completely removing unwanted tattoos. The depth, density and types of colors are probably the biggest determining factors. After each treatment we fragment a little bit more ink and a little deeper into your skin, blistering and scabbing often follows for a week or two. We see some tattoos disappear within 2-3 treatments, as well as in some cases seeing tattoos requiring 8-10 or more treatments for complete removal. Taking care of the treated area is the most important factor in removing a tattoo without a scar. It can be said that the better you take care of the area treated the better the results.

Is the process painful?

Most or our patients say that the laser treatment feels like being snapped by a rubber band and that the discomfort is roughly equivalent to having a tattoo put on. Almost all of our patients are able to resume their normal activities immediately following treatment.

What about lightening an existing tattoo?

Many tattoo artists encourage customers to receive a minimum number of laser treatments to lighten an existing tattoo before covering it with a new one. This will dramatically reduce any chance of the old tattoo appearing through the new one. In most cases, a minimum of 2-4 treatments is all that's required in lightening an existing tattoo.

How do I know what kind of pigmented lesion I have?

Classification of congenital vascular birthmarks has historically been confusing. The medical literature has been inundated by an assortment of terminologies, including hemangioma, nevus flammeus, "stork bites" and port-wine stains. Hemangioma became the generic term used to describe a variety of acquired and congenital vascular lesions. Because this classification was so broad, however, it led to confusion regarding prognosis.

Lesions that develop by undergoing an initial phase of rapid proliferation followed by cessation of growth and involution are classified as hemangioma. Vascular birthmarks that persist throughout the patient's lifetime and grow commensurately are classified as vascular malformation; this group includes port-wine stains.

Hemangiomas tend not to be present at birth but appear during the first few days to weeks of life, often as single small macules. These lesions grow rapidly, becoming red and raised. The lesions increase in size during the following weeks to months, until the child reaches about 12 months of age, when growth stops. Hemangiomas occur most frequently on the face or neck and tend to vary in size from a few millimeters to many centimeters in diameter.

The fully developed hemangioma is often dome-shaped, ranging in color from bright red to dark purple. Approximately 50 percent of hemangiomas spontaneously involutes (diminish) by the time the child is five years of age. Vascular malformations (port-wine stains) are almost always present at birth and occur with equal frequency in males and females.

The port-wine or red color of these lesions is a consequence of enlarged, ectatic (expansion) blood vessels in the dermis, rather than an increase in the number of blood vessels. The incidence of port-wine stains is estimated to be 0.3 percent; 80 to 95 percent are located on the head and neck. Most port-wine stains appear to involve only the skin; however, approximately 5 percent of patients with port-wine stains have concomitant leptomeningeal involvement (Sturge-Weber syndrome) and/or ocular involvement.

At birth, port-wine stains appear as pale pink macules. They darken with age, becoming red to purple, and often develop small nodules within the birthmark, which give the lesions a studded appearance. In extensive lesions, hypertrophy of underlying soft tissues often occurs. These lesions result from blood vessels which become enlarged (or dilated), such as port-wine stains (red birthmarks like Mikhail Gorbachev's) or spider veins. They can also appear when too many blood vessels grow in an area, such as hemangiomas.

What causes pigmented lesions?

Pigmented lesions, birthmarks, brown spots and age spots are created from an excessive concentration of melanin in the skin. Melanin is what gives our skin its color. Everyone has a different amount of melanin in his or her skin. Your physician will evaluate your skin and inform you of the specific type of skin lesion. High concentrations of melanin can be due to various factors. Some types are present at birth, but most occur with age or as a result of overexposure to the sun's damaging rays.

Which pigmented lesions can be treated with laser?

The most commonly treated conditions are solar lentigines, also known as "age spots," "liver spots" or "sun spots"; cafe' au lait birthmarks; and freckles. These benign pigmented lesions are due to an excess of pigment in the skin, usually due to sunlight exposure and congenital factors. Age spots may appear as enlarged light freckles on the face and hands. Cafe' au lait birthmarks may appear as light brown markings anywhere on the body and can be quite large.

What Are The Alternatives To The Procedure?

Pigmented lesions and age spots are cosmetic problems that do not require treatment for medical reasons. Topical therapies include the use of tretinoin (Retin-A), topical vitamin-C or fade creams. These topical therapies are an option, but the results are unpredictable and the response time is 6 months or more for improvement. Make-up is also an option. Cryotherapy can improve pigmented lesions, but often leaves white unpigmented areas or small scars.

Are The Results Permanent?

Most pigmented lesions if completely removed will not return. At times, however, sun exposure may cause café-au-lait spots to return. Permanence can not be guaranteed. You will also continue to develop more age spots and freckles with time, and the appearance of these new lesions should not be confused with recurrence.

What kind of vascular lesions are treated with a laser?

The vascular laser can treat vascular lesions such as telangiectasias or spider veins, port-wine stain birthmarks, and strawberry hemangiomas. Leg veins up to 2 mm. in width can also be eliminated. All of these conditions made up of abnormal blood vessels in the skin. They all vary in severity for example, telangiectasias, or broken blood vessels, usually involve single vessels and are often harmless. Port-wine stains, on the other hand, tend to grow with the patient, usually infants, darken in color and will never go away if left untreated. Hemangiomas grow very rapidly after birth but often go away with time. Some, however may impair vision or breathing and should be treated before they are allowed to advance to this stage. In addition, warts, red and raised scars and inflammatory lesions such as psoriasis can be treated by targeting their rich vascular supply.

Why is treatment with a laser safe and effective?

The laser is safe and effective because of its unique ability to selectively treat the blood vessels of a vascular lesion without adversely affecting the surrounding tissue. Thus, it will eliminate many lesions while leaving the surrounding skin intact. In fact, the laser is so safe that it is recommended for the treatment of infants as young as a few weeks old.

What does the treatment involve?

Treatment with the laser varies from patient to patient depending on the type of lesion, and the size of the affected area. Some lesions, like small broken vessels, will require only a few pulses, while others, like port wine stains, will require many more. Leg veins will sometimes require more than one treatment.

Should certain precautions be taken after the treatment?

Immediately following treatment, some patients find the application of an ice pack to be soothing to the treated area. Some patients may require the application of a topical antibiotic cream or ointment. In addition, care should be taken in the first few days following treatment to avoid abrasive skin cleansers and not scrubbing in the area should take place. A bandage or patch may be helpful in preventing abrasion of the treated area.

Are there any side effects?

Unlike other methods of treatment, the laser greatly reduces the potential for scarring or changes in the skin texture. You will, however, experience some temporary discoloration of the skin around the treatment site. This blue-grey discoloration is called purpura and usually resolves in 5-7 days. When treating leg veins, however, the purpura may last from 7-14 days. Also, depending on your skin type, and the site and size of the lesion treated, some patients may experience a temporary brown discoloration of the skin for a few weeks following treatment. It is always transient, however. These side effects can often be minimized with proper preoperative and postoperative care. The laser can be used with much less purpura but additional treatments might be necessary.

Are there any other precautions that I should know about?

Optimal results will be achieved with the laser if you are not suntanned. It is also recommended that you avoid exposing the treated area to the sun or cover the area with sun block that has been approved by your physician. Because pigment is often closer to the surface of the skin than the blood vessels of a lesion, a lot of pigment, such as in "tanned" or deeply pigmented skin, may act as a barrier to prevent the laser light from reaching the lesion. Therefore, the laser is most effective in lighter skin types.

Where can I find information regarding the number of fertility medicine physicians available at Bumrungrad and detailed information on each doctor?

For a complete list of the Fertility Medicine physicians currently working at Bumrungrad, information regarding their clinic hours, experience and education, please visit our Find a Doctor page and select “OB/GYN – Fertility Medicine” as the Specialty on that page.

What are the different techniques for infertility treatment?

1. Intrauterine Insemination (IUI)

IUI is when sperm that have been "washed" and concentrated are placed directly into the uterine cavity on the day the ovary releases one or more eggs to be fertilized. The hoped-for outcome of intrauterine insemination is for increasing the chance of sperm to swim into the fallopian tubes and fertilize a waiting egg, resulting in pregnancy.

2. In-vitro Fertilization (IVF)

This technique involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory and transferring the embryos into the uterine cavity three to five days after fertilization.

3. Intra Cytoplasmic Sperm Injection (ICSI)

The procedure involves the direct injection of a single sperm into the egg cytoplasm. This is used for couples with either severe male factor infertility or unexplained failure to fertilize with conventional IVF.

The steps involved in GIFT are similar to IVF up to the point of egg retrieval. Egg retrieval is usually performed under general anesthesia, and the eggs and sperm are immediately transferred into a catheter that is used to place the eggs and sperm into the fallopian tube during a laparoscopy. GIFT should only be performed when sperm level is adequate and at least one fallopian tube is open and functional.

ZIFT is a combination of IVF and GIFT: A fertilized egg is transferred into the fallopian tubes. Fertilization takes place in a laboratory, and the zygotes (newly fertilized eggs) are transferred into the fallopian tubes at the time of laparoscopy.

TESE is a common technique to diagnose the cause of azoospermia and obtain sufficient tissue for sperm extraction to be used either fresh or as a cryopreserved (frozen) specimen.

PESA can be completed under local or general anesthesia with the physician inserting a needle attached to a syringe into the epididymis, then gently withdrawing fluid.

6. Blastocyst culture

Until recently, embryos performed in IVF & ET and ICSI were transferred on day two at the fourth cell stage, but with the availability of newer culture media, embryos can now be grown up to the blastocyst stage in three to five days. This increases the chance of implantation and pregnancy.

7. Assisted Hatching

Normally the covering of the embryo called Zona breaks inside the womb after transferring the embryo. The embryo then hatches and is implanted inside the womb. Whenever the embryo fails to hatch, the embryo dies and the procedure fails. In this new technique the embryos are hatched by the means of chemicals or injections before they are transferred inside the womb.

What is the success rate of infertility treatments at Bumrungrad? Does the hospital guarantee the success of infertility treatments?

Pregnancy rates after infertility procedures are largely dependent on the method of infertility treatment. It is best to discuss treatment options with your physician so that together you can decide the most appropriate treatment option(s) for you.

Due to the nature of infertility treatments, Bumrungrad International is unable to guarantee successful results.

How long should I plan to stay in Thailand?

Plan to stay in Thailand at least three to four weeks for the procedure and follow up care.

When is the best time to see the doctor?

Plan to see the doctor for an initial consultation prior to initiating any treatments so that you and your doctor can discuss the treatment option that is best for you and develop your treatment plan. The first visit for treatment should be done at least seven days before your menstruation period.

What investigatory tests will need to be completed prior to undergoing infertility procedures?

For females, a pelvic examination and ultrasound of the pelvic organs are necessary to check for any problems with the uterus or ovaries. In some women, blood tests may be required as well.

For males, a sperm analysis is necessary to investigate the health of sperm. In some cases, men may also require additional blood tests.

What kind of vascular lesions are treated with a laser?

The vascular laser can treat vascular lesions such as telangiectasias or spider veins, port-wine stain birthmarks, and strawberry hemangiomas. Leg veins up to 2 mm. in width can also be eliminated. All of these conditions made up of abnormal blood vessels in the skin. They all vary in severity for example, telangiectasias, or broken blood vessels, usually involve single vessels and are often harmless.

Port-wine stains, on the other hand, tend to grow with the patient, usually infants, darken in color and will never go away if left untreated. Hemangiomas grow very rapidly after birth but often go away with time. Some, however may impair vision or breathing and should be treated before they are allowed to advance to this stage. In addition, warts, red and raised scars and inflammatory lesions such as psoriasis can be treated by targeting their rich vascular supply.

Why is treatment with a laser safe and effective?

The laser is safe and effective because of its unique ability to selectively treat the blood vessels of a vascular lesion without adversely affecting the surrounding tissue. Thus, it will eliminate many lesions while leaving the surrounding skin intact. In fact, the laser is so safe that it is recommended for the treatment of infants as young as a few weeks old.

What does the treatment involve?

Treatment with the laser varies from patient to patient depending on the type of lesion, and the size of the affected area. Some lesions, like small broken vessels, will require only a few pulses, while others, like port wine stains, will require many more. Leg veins will sometimes require more than one treatment.

Should certain precautions be taken after the treatment?

Immediately following treatment, some patients find the application of an ice pack to be soothing to the treated area. Some patients may require the application of a topical antibiotic cream or ointment. In addition, care should be taken in the first few days following treatment to avoid abrasive skin cleansers and not scrubbing in the area should take place. A bandage or patch may be helpful in preventing abrasion of the treated area.

Are there any side effects?

Unlike other methods of treatment, the laser greatly reduces the potential for scarring or changes in the skin texture. You will, however, experience some temporary discoloration of the skin around the treatment site. This blue-grey discoloration is called purpura and usually resolves in 5-7 days.

When treating leg veins, however, the purpura may last from 7-14 days. Also, depending on your skin type, and the site and size of the lesion treated, some patients may experience a temporary brown discoloration of the skin for a few weeks following treatment. It is always transient, however. These side effects can often be minimized with proper preoperative and postoperative care. The laser can be used with much less purpura but additional treatments might be necessary.

Are there any other precautions that I should know about?

Optimal results will be achieved with the laser if you are not suntanned. It is also recommended that you avoid exposing the treated area to the sun or cover the area with sun block that has been approved by your physician. Because pigment is often closer to the surface of the skin than the blood vessels of a lesion, a lot of pigment, such as in "tanned" or deeply pigmented skin, may act as a barrier to prevent the laser light from reaching the lesion. Therefore, the laser is most effective in lighter skin types.

How is liposuction performed?

Small incisions are made and the excess fat is suctioned out through these small incisions. Sometimes a tumescent technique is used where a solution of saline (delivery and tumescent agent ), Lidocaine (pain reliever) and epinephrine (prohibits bleeding) are injected into the targeted area. This technique's purpose is to engorge the tissues with the solution for a firmer working area and the fat cells (which are softer) are suctioned out. The epinephrine prohibits bleeding during the operation and less blood is lost during the procedure.

There is a technique which involves ultrasonic waves. These ultrasonic waves excite the tissues water molecules (fat molecules being the target) and literally melt the fat into a liquid for ease of removal by suction. Unfortunately, each patient's molecules may react differently or in the case of unskilled surgeons, may improperly handle the equipment resulting in severe burns.

Either way, the targeted fat is suctioned out, sutures are sometimes used in the closure of incisions, a bit of surgical tape or Steri-Strips? are placed over the incision and a support garment is worn for proper, compact healing.

How many techniques are there for liposuction?

There is the Tumescent technique which is widely used by doctors every where. With the tumescent technique, if the surgeon does not over inject the area with TOO MUCH Lidocaine solution, this technique is proving best. Once upon a time they just shoved the hose in there and sucked away. With the tumescent technique, they engorge the tissues with a saline/Lidocaine solution and suction the fat cells which are not engorged with the solution. This technique also hinders of suctioning out of tissues that are not targeted for removal and lessens bleeding. However, if a surgeon injects too much of the solution the patient can get Lidocaine toxicity which can cause sickness, complications and sometimes death. Although Lidocaine toxicity is most often seen in body sculpture where large amounts of solution in injected within the body and the operation my require a longer period of anesthesia.

There is also a Super-wet technique which is basically like the Tumescent but with not as much solution injected. It breaks down to about the same amount injected as the amount of fat removed.

There is also the Ultra Sonic technique (UAL) which is regularly leaving patents with serious post-operative burns. Apparently the high frequency waves are over-exciting the water particles (or any fluid containing) causing them to boil beneath the skin as well as damaging superficial tissues as well.

And lastly there is the Power-Assisted Liposuction (PAL or MicroAire Technique). PAL is a newer technique where the cannula eases through the fatty tissue (even fibrous) with less trauma than traditional techniques and with no burn risks as with the UAL techniques. This new machine uses a special high-speed "linear reciprocating" suction cannula. You see, with the newer cannula surgeons are able to perform more effective high-volume liposuction in a shorter time, without trauma, especially in more fibrous areas. Fibrous tissue has always been a problem in the buttocks, saddlebags (upper sides of thighs in women), back and the male breast (gynecomastia). The PAL system moves through these areas faster, with less trauma resulting in less work and strain for the surgeon and less pain and a faster recovery in patients.

Is it quite painful? Is there much bruising?

It takes about a week and a half for most of the swelling to subside. There is really not too much bruising with average cases, although it should be looked upon as individual. Some are prone to bruising more than others. You should take your prescribed pain medication to alleviate any pain or discomfort that you may experience.

Is liposuction permanent?

To a certain degree, yes. Although the fat will return if you over eat and gain weight. The remaining fat cells have an extraordinary ability to expand considerably to compensate for any fat cells removed from liposuction. Liposuction, in any application, is not to be used for weigh loss. Patients have died from suctioning out too much of their body's fluids. Your body needs fat and fluid to function. You must realize, that if you gain weight you will re-gain the fat stores in your neck and face. Although it may not look the same or be as much. The fat cells will compensate and engorge themselves and sell. It is reported that fat cells are able to divide if they become too large.

What are the risks of liposuction?

There are more risks with liposuction due to the fat and its surrounding tissues becoming necrotic (dead tissue). If the fat becomes necrotic from lack of blood supply, the fat tends to turn orange-ish clear and drain from the incision. If the tissue becomes necrotic, that's a completely different story. You must have the tissue removed before a major infection develops, possibly causing gangrene. Even with the ultrasonic technique, patients have been known to receive actual burns from the ultrasonic technique. The fat is actually melted within the body by 'exciting' the fat molecules with high frequency radio waves and is suctioned out. There may be asymmetry, hyper-pigmentation (permanent dark spots) from the bruising. Major blood loss is a factor is some cases. As is hematoma and infection. Liposuction is NOT the way to lose weight.

Another risk of liposuction* is pulmonary Thromboemboli. A thromboebolus is a blood clot and this blood clot can break free and travel to the lungs resulting in pulmonary Thromboemboli. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma - leading to the patient becoming 'brain dead' shortly thereafter or in a vegetative state from loss of oxygen to the brain. Pulmonary Thromboemboli can happen within three weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. However, pulmonary Thromboemboli can occur suddenly, without warning. Most patients with P.E. collapse and begin rapid deterioration after attempting to climb a flight of stairs.

*facial liposuction risks are far less than body liposuction due to the amount of fat that is suctioned and disrupted.

What does a typical liposuction consultation entail?

First off, your doctor will discuss your goals with you and he will explain what can be achieved realistically. A surgeon should take into account what your body structure is and be able to recognize where your fat is needed. Which is pretty much everywhere -- just not in excess. There is no "one size fits all" technique when it comes to this procedure. It is all individual.

What should I expect post-operatively?

You may feel a little sore but excessive pain is very rare with liposuction. It's more of an uncomfortable soreness. Your pain relievers prescribed by your doctor should alleviate this pain. You will be asked to wear a support garment postoperatively for the first few days and then only at night for a few weeks if there was excessive removal of facial fat. This will insure proper healing in the surrounding tissues for a more compact appearance.

When will I be able to return to work?

Most patients return to work within 2 weeks. Although some patients have returned just after 5 days. It is highly individual. The swelling is more than likely the main reason people tend to take off work. The bruising, if any, can be camouflaged with cosmetics. Still, you should not bend over or exercise until well after 3 weeks post-op.

When will I be able to see the results?

After the swelling subsides you will begin to notice a difference in the compact appearance of your tissues. It is advised to take before and after photos to fully appreciate the results as a gradual decrease in swelling will give your mind time to accustom itself to the changes. They may not seem too great to you, but with photos your appreciation and understanding of the results are clarified through visual realization.

Where are the incisions made?

The incisions are made within the natural folds of the body which are usually near the pubic area, the inner knees several places along the thighs, etc. There are no folds there normally. Unnecessary scarring is generally avoided in all techniques. Discuss with your doctor his or incision placement of choice and why?

How is liposuction performed?

Small incisions are made and the excess fat is suctioned out through these small incisions. Sometimes a tumescent technique is used where a solution of saline (delivery and tumescent agent ), Lidocaine (pain reliever) and epinephrine (prohibits bleeding) are injected into the targeted area. This technique's purpose is to engorge the tissues with the solution for a firmer working area and the fat cells (which are softer) are suctioned out. The epinephrine prohibits bleeding during the operation and less blood is lost during the procedure.

There is a technique which involves ultrasonic waves. These ultrasonic waves excite the tissues water molecules (fat molecules being the target) and literally melt the fat into a liquid for ease of removal by suction. Unfortunately, each patient's molecules may react differently or in the case of unskilled surgeons, may improperly handle the equipment resulting in severe burns.

Either way, the targeted fat is suctioned out, sutures are sometimes used in the closure of incisions, a bit of surgical tape or Steri-Strips? are placed over the incision and a support garment is worn for proper, compact healing.

How many techniques are there for liposuction?

There is the Tumescent technique which is widely used by doctors every where. With the tumescent technique, if the surgeon does not over inject the area with TOO MUCH Lidocaine solution, this technique is proving best. Once upon a time they just shoved the hose in there and sucked away. With the tumescent technique, they engorge the tissues with a saline/Lidocaine solution and suction the fat cells which are not engorged with the solution. This technique also hinders of suctioning out of tissues that are not targeted for removal and lessens bleeding. However, if a surgeon injects too much of the solution the patient can get Lidocaine toxicity which can cause sickness, complications and sometimes death. Although Lidocaine toxicity is most often seen in body sculpture where large amounts of solution in injected within the body and the operation my require a longer period of anesthesia.

There is also a Super-wet technique which is basically like the Tumescent but with not as much solution injected. It breaks down to about the same amount injected as the amount of fat removed.

There is also the Ultra Sonic technique (UAL) which is regularly leaving patents with serious post-operative burns. Apparently the high frequency waves are over-exciting the water particles (or any fluid containing) causing them to boil beneath the skin as well as damaging superficial tissues as well.

And lastly there is the Power-Assisted Liposuction (PAL or MicroAire Technique). PAL is a newer technique where the cannula eases through the fatty tissue (even fibrous) with less trauma than traditional techniques and with no burn risks as with the UAL techniques. This new machine uses a special high-speed "linear reciprocating" suction cannula. You see, with the newer cannula surgeons are able to perform more effective high-volume liposuction in a shorter time, without trauma, especially in more fibrous areas. Fibrous tissue has always been a problem in the buttocks, saddlebags (upper sides of thighs in women), back and the male breast (gynecomastia). The PAL system moves through these areas faster, with less trauma resulting in less work and strain for the surgeon and less pain and a faster recovery in patients.

Is it quite painful? Is there much bruising?

It takes about a week and a half for most of the swelling to subside. There is really not too much bruising with average cases, although it should be looked upon as individual. Some are prone to bruising more than others. You should take your prescribed pain medication to alleviate any pain or discomfort that you may experience.

Is liposuction permanent?

To a certain degree, yes. Although the fat will return if you over eat and gain weight. The remaining fat cells have an extraordinary ability to expand considerably to compensate for any fat cells removed from liposuction. Liposuction, in any application, is not to be used for weigh loss. Patients have died from suctioning out too much of their body's fluids. Your body needs fat and fluid to function. You must realize, that if you gain weight you will re-gain the fat stores in your neck and face. Although it may not look the same or be as much. The fat cells will compensate and engorge themselves and sell. It is reported that fat cells are able to divide if they become too large.

What are the risks of liposuction?

There are more risks with liposuction due to the fat and its surrounding tissues becoming necrotic (dead tissue). If the fat becomes necrotic from lack of blood supply, the fat tends to turn orange-ish clear and drain from the incision. If the tissue becomes necrotic, that's a completely different story. You must have the tissue removed before a major infection develops, possibly causing gangrene. Even with the ultrasonic technique, patients have been known to receive actual burns from the ultrasonic technique. The fat is actually melted within the body by 'exciting' the fat molecules with high frequency radio waves and is suctioned out. There may be asymmetry, hyper-pigmentation (permanent dark spots) from the bruising. Major blood loss is a factor is some cases. As is hematoma and infection. Liposuction is NOT the way to lose weight.

Another risk of liposuction* is pulmonary Thromboemboli. A thromboebolus is a blood clot and this blood clot can break free and travel to the lungs resulting in pulmonary Thromboemboli. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma - leading to the patient becoming 'brain dead' shortly thereafter or in a vegetative state from loss of oxygen to the brain. Pulmonary Thromboemboli can happen within three weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. However, pulmonary Thromboemboli can occur suddenly, without warning. Most patients with P.E. collapse and begin rapid deterioration after attempting to climb a flight of stairs.

*facial liposuction risks are far less than body liposuction due to the amount of fat that is suctioned and disrupted.

What does a typical liposuction consultation entail?

First off, your doctor will discuss your goals with you and he will explain what can be achieved realistically. A surgeon should take into account what your body structure is and be able to recognize where your fat is needed. Which is pretty much everywhere -- just not in excess. There is no "one size fits all" technique when it comes to this procedure. It is all individual.

What should I expect post-operatively?

You may feel a little sore but excessive pain is very rare with liposuction. It's more of an uncomfortable soreness. Your pain relievers prescribed by your doctor should alleviate this pain. You will be asked to wear a support garment postoperatively for the first few days and then only at night for a few weeks if there was excessive removal of facial fat. This will insure proper healing in the surrounding tissues for a more compact appearance.

When will I be able to return to work?

Most patients return to work within 2 weeks. Although some patients have returned just after 5 days. It is highly individual. The swelling is more than likely the main reason people tend to take off work. The bruising, if any, can be camouflaged with cosmetics. Still, you should not bend over or exercise until well after 3 weeks post-op.

When will I be able to see the results?

After the swelling subsides you will begin to notice a difference in the compact appearance of your tissues. It is advised to take before and after photos to fully appreciate the results as a gradual decrease in swelling will give your mind time to accustom itself to the changes. They may not seem too great to you, but with photos your appreciation and understanding of the results are clarified through visual realization.

Where are the incisions made?

The incisions are made within the natural folds of the body which are usually near the pubic area, the inner knees several places along the thighs, etc. There are no folds there normally. Unnecessary scarring is generally avoided in all techniques. Discuss with your doctor his or incision placement of choice and why?

How is liposuction performed?

Small incisions are made and the excess fat is suctioned out through these small incisions. Sometimes a tumescent technique is used where a solution of saline (delivery and tumescent agent ), Lidocaine (pain reliever) and epinephrine (prohibits bleeding) are injected into the targeted area. This technique's purpose is to engorge the tissues with the solution for a firmer working area and the fat cells (which are softer) are suctioned out. The epinephrine prohibits bleeding during the operation and less blood is lost during the procedure.

There is a technique which involves ultrasonic waves. These ultrasonic waves excite the tissues water molecules (fat molecules being the target) and literally melt the fat into a liquid for ease of removal by suction. Unfortunately, each patient's molecules may react differently or in the case of unskilled surgeons, may improperly handle the equipment resulting in severe burns.

Either way, the targeted fat is suctioned out, sutures are sometimes used in the closure of incisions, a bit of surgical tape or Steri-Strips? are placed over the incision and a support garment is worn for proper, compact healing.

How many techniques are there for liposuction?

There is the Tumescent technique which is widely used by doctors every where. With the tumescent technique, if the surgeon does not over inject the area with TOO MUCH Lidocaine solution, this technique is proving best. Once upon a time they just shoved the hose in there and sucked away. With the tumescent technique, they engorge the tissues with a saline/Lidocaine solution and suction the fat cells which are not engorged with the solution. This technique also hinders of suctioning out of tissues that are not targeted for removal and lessens bleeding. However, if a surgeon injects too much of the solution the patient can get Lidocaine toxicity which can cause sickness, complications and sometimes death. Although Lidocaine toxicity is most often seen in body sculpture where large amounts of solution in injected within the body and the operation my require a longer period of anesthesia.

There is also a Super-wet technique which is basically like the Tumescent but with not as much solution injected. It breaks down to about the same amount injected as the amount of fat removed.

There is also the Ultra Sonic technique (UAL) which is regularly leaving patents with serious post-operative burns. Apparently the high frequency waves are over-exciting the water particles (or any fluid containing) causing them to boil beneath the skin as well as damaging superficial tissues as well.

And lastly there is the Power-Assisted Liposuction (PAL or MicroAire Technique). PAL is a newer technique where the cannula eases through the fatty tissue (even fibrous) with less trauma than traditional techniques and with no burn risks as with the UAL techniques. This new machine uses a special high-speed "linear reciprocating" suction cannula. You see, with the newer cannula surgeons are able to perform more effective high-volume liposuction in a shorter time, without trauma, especially in more fibrous areas. Fibrous tissue has always been a problem in the buttocks, saddlebags (upper sides of thighs in women), back and the male breast (gynecomastia). The PAL system moves through these areas faster, with less trauma resulting in less work and strain for the surgeon and less pain and a faster recovery in patients.

Is it quite painful? Is there much bruising?

It takes about a week and a half for most of the swelling to subside. There is really not too much bruising with average cases, although it should be looked upon as individual. Some are prone to bruising more than others. You should take your prescribed pain medication to alleviate any pain or discomfort that you may experience.

Is liposuction permanent?

To a certain degree, yes. Although the fat will return if you over eat and gain weight. The remaining fat cells have an extraordinary ability to expand considerably to compensate for any fat cells removed from liposuction. Liposuction, in any application, is not to be used for weigh loss. Patients have died from suctioning out too much of their body's fluids. Your body needs fat and fluid to function. You must realize, that if you gain weight you will re-gain the fat stores in your neck and face. Although it may not look the same or be as much. The fat cells will compensate and engorge themselves and sell. It is reported that fat cells are able to divide if they become too large.

What are the risks of liposuction?

There are more risks with liposuction due to the fat and its surrounding tissues becoming necrotic (dead tissue). If the fat becomes necrotic from lack of blood supply, the fat tends to turn orange-ish clear and drain from the incision. If the tissue becomes necrotic, that's a completely different story. You must have the tissue removed before a major infection develops, possibly causing gangrene. Even with the ultrasonic technique, patients have been known to receive actual burns from the ultrasonic technique. The fat is actually melted within the body by 'exciting' the fat molecules with high frequency radio waves and is suctioned out. There may be asymmetry, hyper-pigmentation (permanent dark spots) from the bruising. Major blood loss is a factor is some cases. As is hematoma and infection. Liposuction is NOT the way to lose weight.

Another risk of liposuction* is pulmonary Thromboemboli. A thromboebolus is a blood clot and this blood clot can break free and travel to the lungs resulting in pulmonary Thromboemboli. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma - leading to the patient becoming 'brain dead' shortly thereafter or in a vegetative state from loss of oxygen to the brain. Pulmonary Thromboemboli can happen within three weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. However, pulmonary Thromboemboli can occur suddenly, without warning. Most patients with P.E. collapse and begin rapid deterioration after attempting to climb a flight of stairs.

*facial liposuction risks are far less than body liposuction due to the amount of fat that is suctioned and disrupted.

What does a typical liposuction consultation entail?

First off, your doctor will discuss your goals with you and he will explain what can be achieved realistically. A surgeon should take into account what your body structure is and be able to recognize where your fat is needed. Which is pretty much everywhere -- just not in excess. There is no "one size fits all" technique when it comes to this procedure. It is all individual.

What should I expect post-operatively?

You may feel a little sore but excessive pain is very rare with liposuction. It's more of an uncomfortable soreness. Your pain relievers prescribed by your doctor should alleviate this pain. You will be asked to wear a support garment postoperatively for the first few days and then only at night for a few weeks if there was excessive removal of facial fat. This will insure proper healing in the surrounding tissues for a more compact appearance.

When will I be able to return to work?

Most patients return to work within 2 weeks. Although some patients have returned just after 5 days. It is highly individual. The swelling is more than likely the main reason people tend to take off work. The bruising, if any, can be camouflaged with cosmetics. Still, you should not bend over or exercise until well after 3 weeks post-op.

When will I be able to see the results?

After the swelling subsides you will begin to notice a difference in the compact appearance of your tissues. It is advised to take before and after photos to fully appreciate the results as a gradual decrease in swelling will give your mind time to accustom itself to the changes. They may not seem too great to you, but with photos your appreciation and understanding of the results are clarified through visual realization.

Where are the incisions made?

The incisions are made within the natural folds of the body which are usually near the pubic area, the inner knees several places along the thighs, etc. There are no folds there normally. Unnecessary scarring is generally avoided in all techniques. Discuss with your doctor his or incision placement of choice and why?

What is the success rate of dental implants?

This depends on where the implants are placed and their function. The best placement of implants is in the front portion of the lower jaw where success can be as high as between 98-100%. In other parts of the mouth, success rates can drop significantly to the 90-95% range.

What are dental implants?

A dental implant is a titanium screw that is secured into the jaw bone. It can be a singular tooth replacement or it can be a support for a cap or a bridge.

Who is the ideal patient for dental implants?

Anyone in reasonable health who wants to replace missing teeth. You must have enough bone in the area of the missing teeth to provide for the anchorage of the implants.

How long after a dental implant is placed can it be used to anchor my new teeth?

The protocol that was originally developed clearly indicates waiting 90 days for the lower jaw and 180 days for the upper jaw before beginning the construction of the new dental prosthesis that will be supported by the implants.

Does it hurt when dental implants are placed?

The actual procedure to surgically place a dental implant is done under local anesthesia and usually is not painful.

Who is a candidate for colon screening?

Anyone who is over 50 years old. It should be repeated every 10 years, or by physician recommendation. (Picture 1 on Colonoscopy Procedure Page)

Individuals with a family history of colorectal cancer, or other risk factors.

What risk factors are associated with Colorectal Cancer (CRC)?

The exact cause of CRC is not known; however, studies show a relationship between increased socio-economic development and diet (excess of saturated animal fat) with an increased incidence of CRC. Other factors include:

Increasing age (over 60 years old)

Other diseases of the digestive tract, including ulcerative colitis or Crohn’s Disease

Why should I undergo colon screening? What are the benefits?

Statistics from the National Cancer Institution state that colorectal cancer is one of the top 3 types of cancers registered in Thailand, both in men and women.

Colon screening allows your physician to locate any polyps or abnormal tissues that are present. Once identified, these can usually be removed immediately and biopsied if necessary.

If I don’t want to do a colonoscopy, what other procedures are available?

Colonoscopy is the only procedure that screens the entire colon and allows your doctor to immediately remove any polyps or abnormal tissues that may be present. However, other screening options include:

Stool exams (Fecal occult blood test): should be done annually. However, if blood is found in the stool, a colonoscopy may still be needed to look for the source.

Virtual colonoscopy (CT Colonography): is another colon screening option. However, if a polyp or abnormal tissue is found, you may still need to have a colonoscopy to remove/biopsy it.

Sigmoidoscopy is an option to screen the Sigmoid only. However, this procedure does not screen entire colon.

What is the possibility for me to need a polypectomy or biopsy during colonoscopy or gastroscopy?

From our 2010 statistics, we found that about 46% of the procedures done in Bumrungrad also needed a polypectomy or biopsy. Of these, 3.5% of the polyp/tissue was cancerous. However, this statistic includes patients who come with existing symptoms and repeat procedures.

Can I complete a Check-up screening package and perform the GI screening on the same day?

Yes, you can; however, it is not recommended to do both on the same day. To complete both, you would need to fast for almost 20 hours. Check-up packages require patients to fast for 9 hours before blood tests and the abdominal ultrasound. Then, you would need to continue fasting throughout the check-up process, followed by approximately 5-6 hours of fasting during the GI screening procedure before eating or drinking anything.

If I am taking a blood thinning or anti-coagulant medication, why can I not undergo a GI screening procedure immediately? If it was during my check-up that my physician recommended that I have a GI screening procedure, can I meet the GI doctor same day

If you are regularly taking anticoagulant medications, there is an increased risk of excessive bleeding during a GI screening procedure. Therefore, you would need to temporarily stop taking anticoagulant medications for at least 7 days prior to the procedure. However, you must first confirm with your physician that you are safe to do so. You can have a pre-procedure physical examination on the same day as your check-up and then make an appointment for your scope when you’re ready.

Is there any possibility of having the GI screening done before my check-up package to save time?

From our experience, patients are unable to complete the check-up process after GI screening due to the affects of sedatives required during the procedure.

At what time should the patient arrive at the Digestive Disease Center if they would like to complete both the consultation and the GI screening procedure on the same day?

Patients should be able to complete both as long as their appointment with the GI doctor is before 2 pm and they begin the bowel preparation process before 3 pm.

What sets us apart from other hospitals?

We use only the latest technology

We boast a brand new facility with a private preparation area

Our GI specialists have extensive experience in the screening, diagnosing and treatment of GI conditions.

When will I get the result of the procedure?

The result of the CLO test and endoscopy report will be provided on the same day. It will take about 3 days for a pathology report, if needed. The physician will make another appointment or call you for reporting the result.

Will I need to stay in the hospital?

The procedure can be done in one day on an outpatient basis. It will take about 2-3 hours for preparing your bowel, 30-60 minutes for performing the procedure, and 2 hours for resting in the recovery area. We recommend you to arrange someone to pick you up after the procedure. Patients should not drive for at least 12 - 24 hours after the colonoscopy due to affects from the sedatives.

Will it hurt?

No. During a colonoscopy, patients will receive a sedative through their vein to help keep them relaxed. After the colonoscopy, patients will be taken care of in a recovery room for about two hours. Cramping or bloating may occur during the first hour after the procedure because of some pumped-in air left in the abdomen. Patients will feel better after flatulating. This symptom will disappear within 24 hours.

If I need to do biopsy or polypectomy, can I apply for the package?

Yes. The biopsy, polypectomy, or other procedures performed during the scope will be added to your bill separately.